Dreaming Of A Time
THE
UNIVERSITY OF NORTH CAROLINA
at
CHAPEL HILL
Robert Rodgers Korstad
Digitized by the Internet Archive
in 2011 with funding from
State Library of North Carolina
http://www.archive.org/details/dreamingoftimescOOkors
N.C. DOCUMENTS
CLEARINGHOUSE
JUN 13 1990
N.C. STATE LIBRARY
RALEIGH
Dreaniins Of A Time
The School of Public Health
THE
UNIVERSITY OF NORTH CAROLINA
at
CHAPEL HILL
1939-1989
Robert Rodgers Korstad
Copyright © 1990 by the School of Public Health, The
University of North Carolina at Chapel Hill. All rights
reserved.
Production by UNC Printing Department
Design by Cranine Brinkhous
Library of Congress Cataloging in Publication Data
Korstad, Robert Rodgers
Dreaming Of A Time; The School of Public Health, TTie
University of North Carolina at Chapel Hill, 1939-1989
ISBN 0-89055-324-6
90-60829
GIF
HTable of Content^
HI
Acknowledgmeiits v
r 1
PREPARING THE WAY 1
Chapter 2
THE EARLY YEARS 25
Chapter 3
DOCTORS OF THE BODY POLITIC 49
Chapter 4
FOR SCIENCE AND SOCIETY 79
CONFLICT AND CHANGE 109
PRACTICE WHAT YOU TEACH 141
>gue 171
Notes 181
Photograph Credits
Bradford Bachrach: p. 95.
Betty Ficquett: p. 41 (left).
Hilton Goulson: p. 99.
Dorothy Mayes: p. 134.
North Carolina Collection, University of North Carolina at Chapel Hill
pp. 14, 15, 20, 23 (bottom), 27, 34, 62.
North Carolina Division of Archives and History: pp. 5, 18, 24, 25, 30,
38, 74.
Daniel Okun: pp. 80, 81, 131.
Rockefeller Archive Center: pp. 8, 11, 16, 19.
Eunice Tyler: 39, 41 (right), 42, 43, 45, 46, 48 (top), 60.
Bailey Webb: pp. 32, 35, 36.
The other photographs in the book are part of the School of Public
Health Collection.
IporeworlH)
A sense of enormous excitement and satisfaction prevails as we
celebrate the 50th Anniversary of the School of Public Health
and dedicate the McGavran-Greenberg Hall and the Baity
Laboratory. At this critical juncture of our history, we need to pause
and reflect on our origin, mission, and achievements, which are well
documented in this volume.
The expansion of the school facilities, the growth of the faculty
and student bodies, the quality and dedication of the staff, the superb
quality of the research, the technical assistance and continuing education
offered to professionals in North Carolina, and the commitment of the
faculty to teaching excellence are all clear achievements of which we
are proud. Of equal importance, this book chronicles the many contri-
butions of individual faculty and staff, living and dead, who have had
a profound effect on what we are today. It is most gratifying to me that
we have the opportunity to review their many accomplishments and to
acknowledge our debt to them.
At the same time, it is appropriate that we recognize that there
have been disagreements over the appropriate mission of the school, and
that sincere men and women have held different, sometimes radically
different, views of what our school should be. Some of these differences
have been resolved; others are with us today. So must it be, lest we
not be true to our heritage, or to the spirit of inquiry that is the
primary purpose of an academic institution.
At this moment in the evolution of the school it is appropriate to
reflect on the lessons of our history. While it is instructive, indeed
necessary, for us to understand how we have become what we are, we
must also recognize that not all of the accommodations to past realities
are appropriate for the future, lb be consistently ranked in the top
echelon of schools of public health would indicate an institution of
considerable strength and vigor. Organizations, however, cannot be
complacent and ignore the changing realities of a dynamic society. Our
tradition of departmental autonomy, for example, presented few obstacles
to interdisciplinary efforts when the entire faculty could, and often did,
meet around one conference table. While maintaining strong depart-
ments necessary to address societal problems in the next decades, we
must discover ways to enhance cooperative efforts, which our current
structure sometimes discourages. While continuing to support a strong
research orientation in our faculty, we cannot minimize the fundamental
importance of encouraging outstanding teaching and service programs.
And while the School of Public Health can be justly proud of the
leadership we have shown in recruiting women and minority faculty,
staff, and students, we still have a long way to go. We cannot rest on
past success but must vigorously pursue a goal of greater representation
by women and minorities in all areas of the school.
Robert Korstad has shown us in this volume where we have been
and something of how we came to be what we are. I am proud of our
accomplishments, grateful for our differences, and confident that the
School of Public Health will continue to make progress in teaching,
research, and service programs. Let us not forget that this is a profes-
sional school dedicated to the maintenance of health and prevention of
disease. Public service is not only a slogan for us; it is our mission. We
may disagree on the mechanisms, on strategies, even on definitions of
health and disease. Whatever the future brings us, let it be known that
we will always care. If this book teaches us anything, it is that good
people did care.
Michel A. Ibrahim, M.D.
Dean
A cknov
7I
rompiling a history of the School of Public Health at the
University of North Carolina at Chapel Hill in the short
time we had available required supportive efforts from
many people. Dean Michel Ibrahim's enthusiasm made the whole
thing possible. The members of the 50th Anniversary Dedication
committee — Harriet Barr, Pam Home, Richard House, Robert
Moorhead, and Linda Parker— read every word more times than
they would have liked, but always had helpful suggestions. Harriet
Barr shared her knowledge and love of the school and the many
photographs she has collected over the years. Mike Martin,
Frances Weaver, and Marshall Bullock of the University Archives
led me through the extensive records of the school and provided
me with much useful information on the university. The Dean's
Office staff— Melinda Walden, Shirley Clements, Terri Davis,
Gail Gibbs, Delores Gold, Rosa Laney, Jennie Maurer, Mary
McCurdy, Barbara Seago, Sylvia White, and Betty Sue Yow—
helped me over and around many bureaucratic hurdles and
helped make my eighteen months at the school particularly
enjoyable. Jean Allen, Donna Cooper, and Nancy Cant showed
me the ropes at the Kron building. Gail Gibbs located school
records in remote corners of Rosenau Hall and took care of many
administrative details. Jennie Maurer transcribed the interviews
and navigated the minefields of word processing programs. Her
good cheer and dependability saw me through some anxious
moments. Linda Waldrop provided good advice along the way,
but her special concern in the final stages made this a better
book. Bill Herzog, Bert Kaplan, Daniel Okun, and Sharon
Schramm gave the manuscript the benefit of their rich knowl-
edge of the school. Jacquelyn Dowd Hall and James Leloudis of
the Department of History read many drafts and DREAMING
OF A TIME benefitted from their considerable intellectual and
editorial abilities. Winston Fitzpatrick copy-edited the manuscript
with great care and patience. Debbie Atkinson proof-read the
final copy with a watchful eye. Cranine Brinkhous's design cap-
tured the spirit of the school, and her remarkable equanimity
kept us on course. Finally, Bob Moorhead's love of history and
his commitment to the School of Public Health made this book
a reality.
Robert Rodgers Korstad
Chapel Hill, January, 1990
r^hapter 1
PREPARING THE WAY
Lj
n June 7, 1940, the Board of Trustees of the University of
^ North Carolina officially created the School of Public Health
at Chapel Hill. That act represented the culmination of a
twenty-year attempt to build a permanent educational center for public
health professionals. No single incident marked the beginning of the
school. There were many false starts and small beginnings. But a sequence
of events in the fall of 1935 crystallized those efforts and did more
than anything else to give direction and character to the enterprise. Dr.
Carl V. Reynolds, state health officer from 1934 to 1948, recalled:
It was my habit to read the [Raleigh] hleivs and Observer on rising
in the morning, realizing that if there were news of importance,
with its eagle eye for news, that paper would have it. It was that
morning of all mornings, I saw an announcement of Dr. Milton J.
Rosenau's retirement from Harvard School of Medicine. I envisioned,
if we could secure the services of that nationally and internationally
known man of many parts and the father of preventive medicine,
who sought to give a healthier, happier and more abundant life to
his fellow man, it would be the fulfillment of a fond dream come
true. Realizing that an official invitation would have to come from
the University of North Carolina, I hastened without notifying my
office, to Chapel Hill for a conference with the dean of the medical
school and my friend Dr. Charles S. Mangum. After [I made] my
wishes known, Charles's reply was, "Carl, you can't get Rosenau to
come here." My answer was a challenge, "Hell's Fire, shoot at the
moon and you might hit it." The Dean surrendered and said, "Well,
Carl if you feel that strongly about it, I will risk a three cent stamp
on him."'
Dean Mangum promptly wrote to Rosenau, describing the uni-
versity's plans to establish a public health training program and the
importance of finding the right man to head the effort. "It occurred to
me," he concluded, "that it might be possible that you could be interested
in coming to this delightful climate and spend a while in Chapel Hill,
in the foothills of the famous Piedmont section of North Carolina, so
near Pinehurst, where we have flowers in bloom and play tennis and
golf the year round. "^
Unbeknownst to either Reynolds or Mangum, Rosenau had not
retired voluntarily. Harvard required mandatory retirement at age sixty-
five, but Rosenau had no desire to leave his life's work. (He later confided
to a colleague, "You can't retire a man who's not tired.") Rosenau imme-
diately expressed interest in the position and set in motion a series of
exchanges that would lead to his appointment as director of the Division
of Public Health in the School of Medicine.^
Milton J. Rosenau was at the time one of the premier figures in
public health in the United States, and his presence gave the division
instant national exposure. Born in Philadelphia in 1869, Rosenau received
his M.D. from the University of Pennsylvania before doing postgraduate
work in Germany. He joined the United States Public Health and
Marine Hospital Service in 1890, directing the service's hygienic labora-
tory (the forerunner of the National Institutes of Health) from 1899 to
1909. In 1909 Rosenau took a newly established chair in preventive
medicine at Harvard Medical School, the first of its kind in the United
States, which he held until his retirement in 1935. There he helped
establish and direct the first university-based public health training
center, the Harvard-Massachusetts Institute of Technology School for
Health Officers.
Rosenau's medical and research interests ranged widely. His work
at the hygienic laboratory included standardization of diphtheria and
tetanus antitoxins; controls for yellow fever, tuberculosis, smallpox, and
rabies; and methods for pasteurizing milk. At Harvard he trained a
new generation of doctors and health officials in the techniques of
preventive medicine. His book, Preventive IsAedicine and Hygiene, pub-
lished in 1913, became the standard text in the field and in revised
form is still in use today.'*
Rosenau no doubt deserved the appellation "Father of Preventive
Medicine," but the modern public health movement can trace its roots
back nearly two centuries to the industrial revolution in Great Britain.
"The same process that created the market economy, the factory, and
the modern urban environment," wrote historian George Rosen, "also
brought into being the health problems that made necessary new means
of disease prevention and health protection." Poverty, overcrowding,
poor sanitation, and geographical mobility, which were the negative
outcomes of urbanization and industrialization, created conditions favor-
able to the spread of diseases that threatened all segments of society. ^
Until the end of the nineteenth century, two schools of thought
concerning the cause and prevention of disease predominated. Conta-
gionists located the cause of disease in infective agents that could be
transferred by people, by intermediate carriers, or through the air. They
advocated strict quarantine to protect the community at large. Adherents
of a miasmatic theory contended that communicable diseases arose
from effluvia produced by decaying organic matter. They fought for
sanitary reform. Generally, some combination of these two theories
defined public health policy, and the engineers, social reformers, and
physicians who shared the leadership of the movement focused their
efforts on cleaning up the environment, maintaining a clean water
supply, and quarantining affected areas.*
Revolutionary changes in the scientific understanding of disease
and its prevention took place in the late nineteenth century. A series
of discoveries by European scientists established "that specific microscopic
creatures rather than vague chemical miasmas produce[d] infectious dis-
eases." As this germ theory gained wide acceptance, the individual,
rather than the whole society, became the focus of public health. Bac-
teriology superseded engineering as the science of public health, and
the medical doctor began to challenge the engineer as the spokesman
for the movement.^
During the Progressive Era, American reformers used these discov-
eries to attack the health problems that multiplied as waves of immigrants
filled the slums and sweatshops of northern cities. One wing of the
public health movement focused on the inefficiency of unregulated
economic activity that neglected the public and private needs of the
less fortunate. This group advocated the expansion of scientific knowledge
and the application of sound business practices to the delivery of health
services. A smaller group of reformers highlighted the injustices of a
competitive marketplace. They too believed scientific advancements
held the answer to many health problems, but they also stressed the
need for improvements in housing, working conditions, and access to
medical services.
Prominent among those who stressed the larger social environment
were Alice Hamilton and Charles-Edward A. Winslow. In 1920 Hamilton
discovered that lead poisoning was killing thousands of American workers.
Campaigning for the improvement of working conditions, she almost
single-handedly founded the practice of industrial hygiene. Winslow,
whose thinking would have an impact on some of the major figures in
public health at Chapel Hill, advocated an expansive definition of public
health as "the science and art of preventing disease, prolonging life, and
promoting physical health and efficiency through organized community
efforts.''^
The trajectory of public health efforts in the South paralleled that
in Europe and the northern United States; only the timing differed.
The persistence of a rural, agricultural economy precluded a dramatic
increase in public health problems in the antebellum South. North
Carolina and other southern states had their share of illnesses, early
deaths, and even occasional epidemics, but these struck the slave popu-
lation disproportionately. They were seen, in any case, as natural occur-
rences, not something to be prevented by man. Sustained efforts to
improve the health of the Souths citizens began in the years after the
Civil War. Smallpox and typhoid epidemics swept the region as Con-
federate soldiers returned home, and freed men and women gathered in
towns. After the war, the creation of a free labor market, the rise of
sharecropping, the expansion of the tobacco manufacturing and cotton
textile industries, and the growth of Piedmont urban areas created even
greater health problems.
In 1877 the North Carolina legislature established the State Board
of Health to advise lawmakers on sanitary matters affecting the health
of citizens. Initially, the board had little power and few resources; its
primary objective was to educate North Carolinians about possible
health risks. But over the years the efforts of its first two secretaries,
Dr. Thomas F. Wood and Dr. Richard H. Lewis, and growing public
awareness of health issues increased the board's influence. The board
became involved in the control and prevention of contagious diseases,
the improvement of sanitary conditions, the collection of vital statistics,
and the organization of county health boards. The board's Health Bulletin
was the first state publication in the country to issue monthly reports
on public health.'
Dr. Richard Henry Lewis, Secretary
of tKe State Board of Health, 1892-1909
AN ENEMY TO MANKIND
It slays the tiny baby at mother's breast. Happy, joyous youth falls victim to
poison it spreads. The strength of adult life is of no avail. The fly is no
respecter of age, of sex, of color. It is the enemy of all. It must be fought
and conquered.
An example of the graphics used in the Health
Bulletin to educate North Carolinians about
health issues.
The year 1909 marked a turning point in public health work in
North Carolina. Dr. Lewis had served as president of the American
Public Health Association, and he saw the need for an expansion and
reorganization of public health forces in the state. He convinced law-
makers to increase the State Board of Health's annual appropriation so
that it could employ a full-time state health officer and maintain a
tuberculosis sanatorium. The 1909 North Carolina General Assembly
also gave the board greater authority over public water supplies. '°
Dr. Watson Smith Rankin, dean of the Wake Forest medical school,
replaced Lewis as secretary of the board and as the state's first full-time
health officer. Rankin proved to be an unusually effective administrator,
and during his tenure (1909-25) North Carolina was in the vanguard of
the public health movement. Rankin oversaw phenomenal growth in
public health activities in the state: the annual appropriation of the
State Board of Health increased from $10,500 in 1909 to $340,000 in
1925. Like other Progressive Era reformers, Rankin argued that expendi-
tures for public health were in the long run cost effective. But Rankin
also maintained a relatively broad interpretation of public health that
stressed education and immediate treatment, and he was not afraid at
times to step on the toes of the medical profession. The State Board of
Health gave the Health Bulletin a more popular design and expanded its
circulation. Office staff produced movies and daily newspaper articles
for statewide distribution, while doctors and dentists began examining
children in the public schools, in many cases providing on-site treat-
ment. This program of on-site treatment was viewed with alarm by
some local doctors, who opposed the provision of any medical services
by the state."
Public health issues in North Carolina received a further boost when
John D. Rockefeller gave $1 million to establish the Rockefeller Sanitary
Commission for the Eradication of Hookworm Disease. Around the
turn of the century. Dr. Charles W. Stiles, a zoologist connected with
the United States Public Health Service, documented the prevalence of
the disease among poor white farmers and mill workers in the South.
Underestimating the effects of poverty caused by the Civil War, share-
cropping, and industrial labor, he blamed the parasite for the "inferior
physical development and mental powers" of the "cracker." Stiles had
trouble convincing anyone of the seriousness of the problem, but by
way of Walter Hines Page and the Country Life Commission— a national
Improper privy construction was a
major cause of hookworm infection
in North Carolina.
campaign to uplift rural folk— he met Frederick Gates, who oversaw the
Rockefeller philanthropies. Gates and the Rockefellers already had a
strong interest in the regeneration of the southern economy through
the General Educational Board. Improving the health and increasing
the productivity of the region's workers fit squarely into their plans.
Hookworm was also the perfect disease to highlight the benefits of public
health and philanthropy. Diagnosis and cure were relatively simple and
inexpensive, and the results were quick and dramatic. ^^
The Sanitary Commission identified North Carolina as one of
eleven southern states where a significant number of people suffered from
the disease. Because many North Carolinians distrusted the intentions
of wealthy northerners like the Rockefellers, the Sanitary Commission
worked through a Bureau for Hookworm Control established by the
A hookworm dispensary in
Lincoln County, North Carolina.
COUNTY DISPENl^f^ "
OR FREE TRE.ATMEf
State Board of Health. The bureau identified the areas most heavily
infected by the disease, then provided educational materials to schools
and county health departments in the affected communities. In 1911
the campaign established dispensaries in which teams of doctors, micro-
scopists, and record-keepers set up tents to educate and treat the local
population.'^
The campaign dramatically reduced the incidence of hookworm in
the state, but perhaps more importantly it stimulated greater efforts in
public health. Dr. Benjamin E. Washburn, a Rutherfordton physician
who participated in the hookworm campaign, later observed that "[t]he
cooperative work for the control of hookworm disease marked the be-
ginning of active public health work in North Carolina and in the
South." The campaign also served as an initiation for a number of
North Carolina doctors like Washburn who went on to play important
roles in the national and international public health movement. ''*
The hookworm campaign convinced Wickliffe Rose, director of the
Sanitary Commission and its successor, the International Health Board,
that the county was the most effective unit for public health work and
the county health officer the most important administrator. But Rose
remained equally certain that the movement could not rely on local
physicians and volunteers; it needed trained, professional leaders.
Efficiency-minded reformers such as Rose deplored interference by local
political elites, who often viewed health officers as patronage appoint-
ments. In keeping with the general thrust of Progressive Era reform,
public health advocates sought to develop a cadre of scientifically trained
professionals who would be above partisan political squabbles.'^
The Rockefeller Foundation's vast resources and experience in
restructuring medical education put it in position to assume leadership
in the training of these public health professionals. Under the leadership
of Abraham Flexner, the Rockefeller Foundation's General Education
Board had developed national standards for medical schools seeking
philanthropic support. Schools had to be connected to a large university,
research and educational programs had to be linked to clinical depart-
ments with access to laboratories and a university hospital, and teaching
staffs had to be employed full time. Using Rockefeller funds, Flexner
was able to develop a small group of elite medical schools that were
clinically oriented. A similar strategy evolved in relation to schools of
public health, and for twenty years, until the federal government took
"Selma Ellis of Columbus county. Photograph made at county dispensary. Age
16, weight 62 '/z pounds; anemic ulcer on leg; ill 8 years. He was unable to go
to school or work; in fact he was unable to sit or stand. Notice the change
made in 7 weeks by a few cents worth of thymol."
Before and after photograph of
hookwornn carrier. Such formal
portraits were often used to
highlight the success of the
hookworm treatment and reflected
the reformers' hope that improved
health would instill middle-class
values in former victims.
"Selma Ellis seven weeks later after taking the
hookworm treatment. He was able to walk and run;
weighed 79 pounds; and during the past winter he has
been in school."
10
over in the 1930s, the foundation exercised enormous influence over
public health instruction.'*
In 1915 Wickliffe Rose drew up an initial plan calling for a national
system of public health education, headed by a "central, scientific school"
devoted to research and teaching and supplemented by state programs
that were focused more on short courses and outreach and affiliated
with a medical school and state health departments. In the end, how-
ever, the General Education Board announced its decision to fund a
school at The Johns Hopkins University but made no mention of the
practice-oriented state schools. As was the case with medical education,
scientific research and clinical training remained foremost in the minds
of foundation leaders.'^
f
' li
;^
_^.
Jm.
Outdoor dental health clinic at rural school in Wilson County, North Carolina.
11
Meanwhile, the push to find new markets and sources of raw
materials had taken the industrialized nations into parts of the world
where disease and unsanitary conditions prevented a full utilization of
human and natural resources. Some means had to be found to train
"foot soldiers" for the public health movement at home and abroad.
The Rockefeller Foundation saw the South as another such underde-
veloped' region, and as it expanded its public health work overseas, it
drew on its experience in the region. In 1913, for example, the founda-
tion's International Health Board used the Sanitary Commission's work
in North Carolina as a model for its hookworm campaign in the British
West Indies. When the board decided to establish a training site that
would serve as a model for local health departments, it also looked to
North Carolina for a location, and to a North Carolinian for a director.
Dr. Benjamin E. Washburn set up shop in Wilson County in 1916.
State Health Officer Rankin was so impressed with the success of the
training site that he asked Washburn to direct a new Bureau of County
Health Work in the State Board of Health. The Rockefeller Foundation
continued to pay Washburn's salary, and he moved quickly to set up
county health departments modeled on the Wilson experiment.'^
University of North Carolina officials, aware of the advances in
public health work in the state, were eager to get involved. Health issues
became the focus of much discussion on campus in the spring of 1919.
The influenza epidemic of the previous winter and the surprisingly
poor physical condition of recent army recruits prompted concern among
politicians and educators. In response, the legislature allocated money
for a campus health officer. Dr. William deB. MacNider of the University
of North Carolina School of Medicine saw this as an opportunity to
hire someone who, in addition to serving the university, might also
cooperate with the Board of Health in providing training for public
health workers. He put the idea to State Health Officer Rankin, who
responded coolly, believing that the "scientific and theoretical training"
given at the university would be impractical for public officials. MacNider
eventually won the ear of Rankin's assistant, Benjamin Washburn, who
convinced the board to submit to the university a tentative proposal
for a training school. The board saw two related benefits from such a
plan. First, university students who were exposed to "the rules of hygiene
and sanitation" would become proponents of public health once back
in their own communities. Second, the university could help train des-
perately needed health officers and public health nurses.''
12
CLEAN UP!
Cleanliness Is Next lb Godliness
Boesyour
Back Yard
look
like
this?
Or
like.
this?
Open-top
WeUs
admit.
Filth and
Drainage.
UseaPump
withcancDttop
andha^eaD
drainage away
fioteynirwdL
Is
your Privy
a
Disease
Spreader?
IsitRy-
ti^it, placed
oireraPit &
lOOyaids
fromynrwd?
Doesyoiir
Kitchen
look
like
this?
Or
is it
Screened
Qean S-
Conwenient?
Dirty.
Dusty,
living Rroms
cause
PoorHeaJth
Do you
buy
Food
from stores
like this?
Keep
the House
Clean
Screened &
Comfortable
Or
do you
buy
only
Clean R»d?
^ KEEP CLEAN
Siaie Board of Health , Raleigh, N.C.
Graphic from Health Bulletin
13
Students at the University of North Carolina being sworn into the Students
Army Training Corps in 1918. The poor physical condition of student
recruits prompted calls for health education on campus. Old East is in the
background.
Harry Washburn Chase, President of the
University of North Carolina, 1919-30
University President Harry Washburn Chase welcomed the board's
proposal. He described his vision of the project in a letter to Dr. W. P.
Jacocks, a leading candidate to head up the effort:
It is not our ambition to develop here a school of public health,
nor could we of course hope to compete with the work done at
Harvard or The Hopkins, in case we desired to do so. We merely
want to take a few practical steps toward making it a little easier for
a medical graduate, who is interested in public health matters and
who cannot spend the time to go to a school of public health, to
get some training in the basic things he will need to meet.
The supply of graduates of schools of public health is at present so
limited that it seems clear that health positions in this section
cannot for a number of years be filled from the ranks of such grad-
uates. We therefore feel that if we work out a scheme whereby men
could be given about three months' field work with the State De-
partment of Health, and about three months' training, we will be
meeting a need which is very real and very vital. Naturally such
men would not have the grasp of their problems which graduates of
the formal school of public health would have, but they would be
in far better shape to handle their problems than they would be
with no health training whatsoever. I believe that with the coopera-
tion of our medical school and the engineering faculties, and the
other departments which would be concerned, we could make the
work very much worth while to such men as would come here.^"
Unfortunately, these early plans for public health training faltered.
The university lacked funds for the necessary equipment and capital
14
improvements and had under consideration a competing plan by the
United States Interdepartmental Hygiene Board to establish a Depart-
ment of Hygiene. Rankin continued to voice doubts about the utility
of university training, and there was dissent from professors who feared
the training program might lower the standards of the university. Still,
MacNider did not give up hope. "I would like to see," he wrote Chase,
"and I believe it is our duty to establish a professorship of public health
at the university."^^
The 1920s proved a difficult time for the public health movement
in North Carolina. Dr. Rankin continued to provide strong leadership
during the early years of the decade, and the General Assembly, despite
economic hard times after the end of World War I, steadily increased
its appropriation to the State Board of Health. More and more counties
established full-time health departments, and an ever greater number of
people made use of their services. But the simple expansion of services
could not cover up what Rankin and a number of other progressive
Dr. William deB. MacNider
15
16
public health leaders saw as some fundamental weaknesses of the move-
ment: the continued political control of local health positions and the
general inefficiency of most county health departments.^^
Hoping to make the management of health services as "rational" as
the laboratory dimension, Rankin introduced two schemes designed to
improve the functioning of local health departments and local health
officers. The first was a "piece-work" plan for allocating funds. For
instance, instead of receiving general appropriations for vaccinations,
counties submitted bills for the number they performed. Likewise, the
State Board of Health began evaluating health officers on the basis of
more precise, quantifiable criteria. Such policies had some impact on
health services in the state, but most concerned observers continued to
see the scientific training of public health professionals as the sine qua
non of future progress. ^^
The resignation of Dr. Rankin in 1925 to become director of the
Hospital and Orphan Division of the Duke Endowment seriously
hampered public health activities in North Carolina. Although the
State Board of Health continued to expand its operations until the
early 1930s, much of the board's energy was taken up with personnel
problems and intermittent conflicts with the State Medical Society.
State Health Officer Charles O'H. Laughinghouse discussed starting a
training station for health officers at the newly established Duke Uni-
versity Medical College, but the plan never materialized.^'*
The Great Depression unleashed forces that ultimately created a
more favorable climate for a school of public health in Chapel Hill.
President Frank Porter Graham's leadership put the university in the
forefront of reform efforts in the South. Stringent purse tightening caused
major changes in state government and brought new leadership to the
State Board of Health. Finally, Franklin D. Roosevelt's New Deal pro-
vided funds for health and welfare programs.
The perceived need for greater efficiency in state government
prompted Governor O. Max Gardner to ask the Brookings Institute in
1930 to "prepare for the consideration of the General Assembly a com-
plete, modern, practical setup of government reorganization." The plan
for public health called for the abolition of the State Board of Health
and the relegation of the State Medical Society to an advisory position
in public health matters. Authority would be centralized in an executive
department headed by a commissioner appointed by the governor. The
17
Dr. Charles O'H. Laughinghouse,
State Health 0//icer, 1926-1930
Dr. James M. Parrott,
State Health Officer, 1931-1934
State's medical profession successfully fought the proposed changes, but
the legislature did force the resignation of the standing board and give
the governor veto power over the selection of the state health officer. ^^
The new board selected Dr. James M. Parrott as state health officer.
Parrott went to work quickly, reorganizing the divisions for more effi-
cient functioning and withholding money from counties that appointed
health officers who lacked training or experience in public health ad-
ministration. The latter policy apparently forced Parrott to oppose the
appointment of some long-time friends, but he persevered in his deter-
mination to improve the functioning of health officials throughout the
state. ^^
Soon after taking office, Parrott approached Dr. John A. Ferrell, a
North Carolinian who served as deputy-director of the Rockefeller
Foundation's International Health Division, about a grant for a training
base for county health officials. By requiring such training, he hoped to
weed out "incompetent" doctors who might later be nominated by county
boards of health. Ferrell could offer no encouragement. His response, in
fact, pointed to what the Rockefeller Foundation saw as major deficien-
cies in the public health program in North Carolina. The first problem
was the advanced age of many of the county health officers; the foun-
dation did not encourage training for men over fifty, the average age of
health officers in North Carolina. The second problem was the state's
poverty and its dearth of public health professionals. The foundation
would fund training bases only where the states contributed 50 percent
of the costs and the instructors had "academic, medical and public
18
I
Dr. John A. Ferrell directed the State
Board of Health's hookworm eradica-
tion program before joining the staff
of the Rockefeller Foundation. He
later returned to North Carolina as
Executive Director of the Medical
Care Commission.
health training" of the "first order." North Carolina obviously could not
provide the money, and Ferrell questioned whether the state could find
such instructors. "We had been hopeful" he wrote, "that each of the
more important state health departments would arrange for their young
and best prepared health officers to have courses in schools of public
health, so that for administrative, epidemiological, or teaching assign-
ments the needed personnel could be drawn from within the state."
"North Carolina," he continued, "has not utilized the schools of public
health as have other progressive states." Parrott reminded Ferrell that
the state had produced many able public health men, such as W. S.
Rankin, Benjamin Washburn, and Ferrell himself, only to have them
snapped up by organizations like the Rockefeller Foundation and Duke
Endowment. ^^
Parrott did not abandon his hopes for the training center. Together
with officials of the university, the State Board of Health forged ahead
with a plan for a school in Chapel Hill. Since Orange County did not
have a full-time health officer, the director of the school would also
serve in that capacity. A county nurse, sanitary officer, and health sec-
retary would double as instructors. The director would offer a course in
19
Howard Odum
W. T. Couch
Albert Coates
"It is a strange thing, perhaps, that the
University has grown in stature by getting
down closer and closer to the earth and
the people around it .... Its chief greatness
now, it seems to me, lies in the fact that,
in addition to the glory that was Greece,
the grandeur that was Rome, the immen-
sity of the cosmos, and the infiniteness of
the atom, it has looked around at the
human qualities of the State and the
South. Red-necked farmers have become
as important in its classrooms as Roman
Senators once seemed to be, and for all I
know, may be now. In the University,
where students once paid a black man
named Benny Booth a dime to let them
split a plank over his skull, there is an
increasing concern for what goes on in
other black skulls and in an inescapably
black and white Southern world. The
new School of Public Health (headed by
the world's leading sanitarian who is both
a Yankee and a Jew) is an aspect of the
University's public concern." (Jonathan
Daniels, TarHeels: A Portrait of hlorth
Carolina)
20
preventive medicine at the Medical School in hopes of attracting some
physicians to the public health field. Frank Graham offered strong sup-
port for the effort. Dr. H. G. Baity, dean of the School of Engineering
and a member of the State Board of Health, served as a liaison between
the board and the university. Baity told board members, "We of the
university [consider] none of our functions more vital or of greater value
to the state than the adequate training of personnel who are engaged
in conserving the health o{ our people, making life fuller, longer, and
North Carolina a more wholesome place in which to live."^®
Dr. Parrott's efforts greatly impressed Ferrell. "In my judgment,"
Ferrell wrote to a member of his staff, "conditions in North Carolina
now merit liberal cooperation from our organization." Nevertheless, the
Rockefeller Foundation could find no funds for the proposed training
school. The Depression prohibited philanthropic contributions on the
scale of those in the 1910s and 1920s, but the Rockefeller Foundation
did provide scholarships for two State Board of Health officials and
loaned a member of its own staff to the State Board of Health.^'
By the early 1930s the university had become a center for reform-
minded southerners. Frank Graham stood as a symbol of the school's
liberality, but others like Howard Odum of the Institute for Research in
Social Science and W. T. Couch of the University of North Carolina
Press were also committed to addressing the region's economic and
social problems. ^°
A more cautious group of university-based reformers concentrated
on the waste and inefficiency caused by antiquated bureaucratic structures
and poorly trained government employees. In the early 1930s, Albert
Coates, a law professor at the university, established the Institute of
Government, which offered short courses and provided technical advice
for elected and appointed officials. "The need for training in our gov-
ernmental personnel is painfully apparent," Coates told a gathering of
government officials in 1932. "[T]he hope of popular government is not
so much wrapped up in theories of government, centralized or localized,
as in the effective and efficient handling of governmental affairs by
effective and efficient governmental officers."^'
In 1932 the university also established a School of Public Admin-
istration to provide more formal training for public officials. An important
feature of the new curriculum was a program in public health adminis-
tration designed for physicians who were already engaged in public
21
health work or wished to enter the field. The faculty would be drawn
from various schools on the Chapel Hill campus and from the State
Board of Health in Raleigh. Unfortunately, when the school offered a
"Short Course in Public Health Administration" in the fall of 1933,
only three students registered, and the course had to be canceled. The
shortage of state funds prevented some interested persons from applying,
but the program also needed to build a constituency among health
workers if it was to succeed. ^^
Meanwhile, efforts to devise some workable scheme for public
health work continued. M. V. Ziegler of the Public Health Service
prodded the Medical School, the School of Engineering, and the State
Board of Health to cooperate in offering two twelve-week short courses
during the 1934-35 academic year. The eleven students divided their
time between classroom instruction in sanitary engineering, vital statistics,
and epidemiology and "practical work" at State Board of Health facilities
in Raleigh and at county health departments. The program failed to
attract enough qualified in-state students to justify continuing the courses
the next summer, but Medical School Dean Charles Mangum appealed
to the Public Health Service to provide funding that would allow the
university to accept students from other states. The Public Health Ser-
vice responded favorably, and Mangum prepared a plan for the State
Board of Health to submit to Washington. ^^
This time the plan took, thanks in large measure to heightened
interest in public health at the federal level. Even as Mangum was
drawing up his plan. Congress had under consideration the most far-
reaching piece of social legislation in the nation's history, the Social
Security Act. The act contained key provisions relating to public health.
An advisory committee appointed by President Franklin Roosevelt in
1934 to study long-term economic problems recognized that "illness is
one of the major causes of economic insecurity which threaten people
of small means in good times as in bad." A logical way to deal with
such suffering, the committee concluded, was to take steps to prevent
sickness. The committee recommended grants to states for local health
programs, funds for training public health workers, and additional
personnel for the Public Health Service.^
Although allocations for public health paled in comparison to the
cost of social security, they helped sway influential southern congressmen
who were otherwise critical of the bill. Title VI earmarked much of the
money for states where poverty had limited public health work, and
22
President Franklin D. Roosevelt signing the Social Security Act.
Dr. Charles Mangum
Frank Porter Graham
23
southern public health officials appeared before Congress to support
the legislation. Conservatives also saw public health programs as a way
to counter growing support for national health insurance. The House
and Senate passed the bill in the summer of 1935, and President
Roosevelt signed it on August 14.^^
Anxious to take advantage of the availability of federal funding,
Dean Mangum stepped up his search for someone to head the university's
proposed public health program. State Health Officer Carl Reynolds's
notice of Dr. Milton J. Rosenau's resignation that September came in
the midst of this search. Once Rosenau expressed interest in coming to
Chapel Hill, Dean Mangum invited him to meet with representatives of
the university, the State Board of Health, and the Public Health Service.
On December 13, 1935, the parties agreed to establish a Division of
Public Health in the Medical School that would serve as a regional
training center for public health workers in interstate Sanitary District
Number 2, made up of Delaware, Florida, Georgia, Maryland, North
Carolina, South Carolina, Virginia, and West Virginia. Rosenau accepted
the position as director, and the university agreed to begin admitting
students the following January. ^^
Dr. Carl Reynolds,
State Health Officer, 1934-1947
24
Qhapt
THE EARLY YEAR
tate and university officials greeted Dr. Rosenau's arrival in 1936
with great fanfare. "Your eminence, your training and experience,
and your personality and spirit cause us to welcome you with
sincere enthusiasm," wrote Frank Graham. Newspapers throughout North
Carolina carried word of the new undertaking. State Health Officer Carl
V. Reynolds called Rosenau "the foremost teacher of public health matters
in the world" and the establishment of the school "one of the most
Dr. Milton I. Rosenau
25
important events in this state for the last 25 years." Members of the
Buncombe County Medical Society welcomed the "increased influence
and prestige and power" that would accrue to the university and the
state with Rosenau's arrival.^
Rosenau met his admirers at a gathering of public health officials
and medical educators on the Chapel Hill campus. Frank Graham's
introduction praised Rosenau for his dedication to the cause of public
health and for his willingness at the end of a life filled with honors
and high position to lead the foundling program at Chapel Hill. Then
Dr. Rosenau took the floor. "The epidemiologist is a disease detective"
he told his audience. "[We] hunt and determine the causes of diseases
and then track down the mode of transmission." T) underscore the
tragedy of epidemics, Rosenau described a plague in Stratford-on-Avon
during Shakespeare's childhood. The great dramatist survived, but how
many similar geniuses had been lost, he wondered. "We find monuments
erected to heroes who have won wars, but we have none commemorat-
ing anyone who prevented a war. The same is true with epidemics. But
preventive medicine is coming into its own."^
State and local health associations inundated Rosenau with requests
to address their groups. They looked to him for inspiration for their
own troops and for influence with local political officials. Rosenau ven-
tured out when he could, but setting up the Division of Public Health
required most of his time. Four health officer trainees registered for
courses during the winter quarter, but they were only the beginning.
Students supported by funds from the Social Security Act began arriving
in the spring. By March 28, fifty-one health officers, sanitary engineers,
sanitarians, and sanitary officers had registered. All the members of
Interstate Sanitary District Number 2, with the exception of Maryland,
sent representatives. Rosenau taught epidemiology and the medical faculty
helped out, but the staff of the State Board of Health handled much of
the instruction and classroom work. Without their efforts, the school
could not have opened.^
Rosenau's most pressing tasks that first spring involved raising
money and building a faculty. Unlike The Johns Hopkins and Harvard,
which received substantial endowments as well as operating costs from
the Rockefeller Foundation, the division at Chapel Hill relied on a small
appropriation from the university, funds from the Public Health Service,
and the tuition of students. Rosenau knew about Chapel Hill's limited
26
resources when he took the job, but he had no intention of sitting
still. He aspired to build a program to compete with Harvard and The
Hopkins.''
Rosenau used his personal influence in Washington to secure an
additional allocation from the Public Health Service for two full-time
professors. "This is to relieve the strain on the State Board of Health
and to make a nucleus of a small, well-knit, full-time faculty to carry
on the bulk of the teaching," he wrote Dean Mangum. Dr. Robert E. Fox
joined the faculty as professor of public health administration. As di-
rector of county health work for the State Board of Health, Fox had
been involved in the initiation of public health training at the university.
He taught on a full-time basis for six months of the year and worked
for the board during the remaining time. This arrangement continued
the close cooperation between the state and the university and allowed
the division to grow gradually.^
Dr. Herman Glenn Baity, a professor of sanitary engineering, a
former dean of the School of Engineering at Chapel Hill, and at the
time director of the Public Works Administration (PWA) in North
Dr. Herman G. Baity
27
lu-La till Lu kLiilXuiiliiiiJlrliiil,
28
Carolina, also came on board in the summer of 1936. Baity 's appoint-
ment was anything but routine. The year before, the Board of Trustees,
at the urging of Frank Graham, moved the School of Engineering at
Chapel Hill to North Carolina State College in Raleigh as part of the
1933 consolidation of the schools in Greensboro, Chapel Hill, and
Raleigh. Economics motivated Graham's decision, but the move also
represented an effort to build up the Raleigh campus and make con-
solidation more equitable. Many Chapel Hill alumni and some faculty
members voiced strong opposition to the proposal. Baity among them.
As a concession, Graham placed engineering faculty who did not want
to move to Raleigh in other departments at Chapel Hill. Baity moved
the program in sanitary engineering into the Division of Public Health,
where he retained some of his assistants, his laboratory, and the right
to grant advanced degrees.*
Baity brought many qualities to his position as professor of sanitary
engineering. He was a native North Carolinian, a graduate of the uni-
versity (B.A. in liberal arts in 1917 and B.S. in engineering in 1922), a
member of the State Board of Health, a nationally known sanitary
engineer, and a Public Works administrator with strong connections in
Washington. Among his many distinctions. Baity had been the first
person to earn a doctorate in sanitary engineering (Harvard, 1928).''
When classes began in the fall of 1936, forty-six students enrolled
in the Division of Public Health. Among them was A. Worth Petty, a
recent graduate in sanitary engineering at North Carolina State College
employed by the State Board of Health. The program "looked like a
bonanza," he remembered, "because they were going to pay my salary
and pick up all my travel, and a public health scholarship paid for the
fees, tuition, and books. They broke us up into groups. If you didn't
have a degree you were a sanitary officer. If you had a degree other
than medicine or engineering you were a sanitarian. If you had a degree
in engineering, of course, you were an engineer and a degree in medi-
cine [made you] a health officer."^
Students took courses in public health administration, epidemiology,
vital statistics, principles of sanitation, and child hygiene. "The big
course was epidemiology with Dr. Rosenau," Petty recalled. "This big
book he had written, thicker than the Sears & Roebuck catalog, was
the whole story on everything to do with communicable diseases."
Rosenau did not limit his instructional materials to the lectern, black-
29
Among the early successes of the division was a summer short course in public
health dentistry in 1936. The State Board of Health had initiated an oral hygiene
program in public schools in 1918, and over the years the program had enjoyed
great success. In 1937, the board had seventeen dentists on the staff, who spent
their time in the public schools of North Carolina teaching oral hygiene, examin-
ing the mouths of school children, giving treatment to those who could not
afford to consult a private dentist, and referring others to their family dentist.
Unfortunately, the lack of funds prevented the continuation of the summer short
course after a few years.
30
board, and textbook. The students staged a mock courtroom trial to
demonstrate their knowledge of the social dimensions of disease control.
Dr. Rosenau presided, dressed up in his black robe and wig. "It was a
remarkable course," Petty recalled. "We thoroughly enjoyed it."'
Despite Rosenau's occasional clowning, the program proved quite
rigorous. "Dr. Baity told us that the course they had at Harvard, a
nine-month course with a thesis, was a master of public health; without
a thesis it was a certificate of public health," one student remembered.
"Basically [Chapel Hill] tried to jam nine months of class work without
a thesis into three months. We went to school all day, five and a half
days a week." The faculty realized the program was too intensive and
discussed the possibility of starting a nine-month course. Baity and
Rosenau favored the plan, but State Health Officer Carl Reynolds pro-
tested, saying it would be too difficult for health departments to send
people for that length of time. '°
Dr. Rosenau initially found office space in Caldwell Hall, home of
the Medical School, but the influx of faculty and students into public
health quickly depleted available space. Medical School Dean Charles
Mangum persuaded President Graham to ask the state legislature for
funds for a new building. The legislature appropriated $226,000 in 1937,
but that fell far short of the amount needed. Graham then asked a
committee to prepare a proposal for the Public Works Administration
(PWA). Funds had dried up for PWA projects, but Graham thought that
the federal government's "interest in medical science and public health"
might persuade the agency.^'
The committee's proposal to the PWA highlighted the Souths
acute health needs. Among these were the nation's highest infant and
maternal death rates, as well as "shameful morbidity and mortality rates
due to nutritional deficiencies." The proposal also pointed to the univer-
sity's many efforts to eradicate these problems: the Institute for Research
in Social Sciences, a division of social work and public welfare, and a
division of public health. The lack of a proper building to house the
Medical School and Division of Public Health, the proposal concluded,
handicapped the functioning and expansion of both programs. '^
Members of the university community used their considerable
influence in Washington to speed along the review process and ultimately
win approval for the proposal. H. G. Baity first wrote to Raymond
Rosenberger, a friend on the PWA staff and a Chapel Hill alumnus.
31
A child suffering from
rickets, one of the many
nutritional diseases afflict-
ing southerners in the
1930s and 1940s.
asking him to "assume the personal responsibility of steering this appli-
cation through the proper examining channels." Once the PWA staff
passed on the application, the "next battle [was] to secure an allotment
of funds." Baity wrote to Dr. Rosenau suggesting he contact friends in
the Public Health Service, such as Surgeon General Thomas Parran.
"Since the greatest social appeal can be made in the name of public
health," Baity said, "such expression would have the greatest weight
with the allocating agency." These efforts apparently paid off, for Parran
wrote a strong letter on behalf of the application and it won approval.'^
Rosenau achieved much in his first two years at Chapel Hill. The
university remained a strong moral, if not financial, supporter of the
program. Under Title VI of the Social Security Act, the Public Health
Service continued to provide a substantial portion of the division's
money. The students seemed enthusiastic about their classes. But public
health remained a poor cousin to its academic neighbors, and the North
Carolina program paled in comparison to its counterparts at Harvard
and The Johns Hopkins. Short courses for public health practitioners
were valuable endeavors, but until the division could begin granting
advanced degrees, its scope remained limited and the enterprise lacked
a secure future. Rosenau sought to remedy that situation by asking the
administration to allow the division to confer baccalaureate, master's,
and doctoral degrees in addition to certificates. The Graduate School
32
Dr. Harold Brown joined the faculty in
1937 and served as dean of the school from
' 1941-43.
°^[It] looks as
though we are
developing
into a real
School of
Public
Health.
That's the
dream and I
believe
before long
[it] will be a
fait accompli^
M. J. Rosenau
33
approved the move, and the university administration acknowledged
that approval as the first step in creating an independent School of
Public Health. 14
Continued support from the General Assembly and President
Graham allowed Rosenau to expand his staff. Dr. Harold Brown joined
the faculty in September, 1937, with probably the most impressive aca-
demic credentials of anyone in the field of public health. John Larsh,
who came later to Chapel Hill to work with Brown, explained. "He
had more degrees than anyone I ever knew. He had a bachelor's and a
master's and took his doctorate in science at Hopkins just as I did. He
went from Hopkins to Vanderbilt, teaching parasitology [while] he got
his M.D. Later he went to Harvard and got a Doctor of Public Health.
He was about thirty-five years old before he got his first job, down
here." Harold Gotaas joined the Department of Sanitary Engineering
that same year, and a year later John William Roy Norton came on
board as professor of public health administration. With the addition
of these men, Rosenau felt more hopeful about the future of the enter-
The Medical and Public Health Building (later named MacNider Hall)
34
prise in Chapel Hill. "[I]t looks as though we are developing into a real
School of Public Health. That's the dream and I believe before long [it]
will be a fait accompli."''
The 1939-40 academic year marked a watershed for public health
at Chapel Hill. "We are testing fate on a higher level," Rosenau observed.
First, the division moved into the new Medical and Public Health Building
(now MacNider Hall). The "fine new building with shiny streamlined
equipment" greatly impressed Dr. William A. Mcintosh of the Rocke-
feller Foundation. "A model of architectural design," he noted. "Everyone
who went through the building seemed to be impressed with the fact
that much had been realized for the moderate cost involved both as to
Center, Bailey Webb, Gene Cornatzer, and Bill Taylor, students in
biochemistry. For many years public health had a strong presence in
the Medical School. Harold Brown and later John Larsh taught
parasitology to students at UNC and Duke.
35
Disagreements between Dr. Rosenau (left) and Dr.
MacNider (right) contributed to the creation of an
independent School of Public Health.
the Structure itself and its equipment." The division also offered the last
short course that fall — the last of the kindergarten stage," Rosenau re-
marked. Having been accepted into the graduate school, the division
redesigned its curriculum and admitted fourteen graduate students.'*
Emil Chanlett entered the master's program in sanitary engineering
that year. He divided his time between chemistry and engineering courses
on campus (some of the former engineering professors still taught in
the math department) and public health courses in the new building.
In those days the distance between the two parts of campus seemed
imposing. The Medical and Public Health Building "stood out there by
itself," Chanlett remembered, "almost like a monument. It was considered
to be far away from the rest of the campus." Classroom and laboratory
work consumed most of the students' time, but Chanlett and Buster
Horton, along with two graduate students in parasitology, Bill Taylor
and Thomas Brooks, managed to play handball every day and get over
to Kenan Stadium for Saturday football games.'''
36
A number of factors contributed to the decision to upgrade the
Division of Public Health to a school in 1940, but most important was
the public health profession's desire for independence. The General
Education Board report that led to the founding of The Johns Hopkins
School of Hygiene and Public Health in 1916 contained a strong rec-
ommendation that public health programs remain independent from
medical schools, with their own faculties and budgets. The independent
program at The Hopkins became the standard for other programs. Dur-
ing Rosenau's years at Harvard, medicine and public health were closely
associated, with the Medical School being the more dominant power.
The small size of the initial endeavor at Chapel Hill prevented the
formation of a school on the model of The Hopkins, but Rosenau's
strong personality and Dean Mangum's commitment to the program
made for a healthy relationship. As the division grew, however, problems
emerged. The new dean of the Medical School, William deB. MacNider,
became impatient with what he saw as a conflict between the relative
autonomy of the Division of Public Health and his responsibilities as
dean. Rosenau and MacNider maintained a formal cordiality, but pri-
vately they did not see eye to eye on matters relating to the division.
Finally, in the spring of 1940, the public health faculty petitioned Presi-
dent Graham for a change in the status of the Division of Public Health
to the School of Public Health. Graham and the Board of Trustees
approved the petition on June 7, 1940.'^
The school also launched its first major research project at that
time. Venereal disease had always been a major concern of public health
officials. But society's unwillingness to separate medical issues from moral
concerns prevented significant progress in eradicating the disease. The
campaign against VD received a major boost in 1936 with President
Roosevelt's appointment of Thomas Parran, Jr., as surgeon general. As
former chief of the Public Health Service's Venereal Disease Division
and most recently New York state health commissioner, Parran advo-
cated public discussion of VD. The publication of Parran's Shadow on
the Land, his identification of VD as the nation's number one health
problem, the passage of the National Venereal Disease Control Act— all
these helped change public attitudes and generate a commitment to
bringing the problem under control. '^
In this climate of increased national concern, the Z. Smith Reynolds
Foundation announced in December, 1937, that income from its $7
million endowment would go to the North Carolina State Board of Health
37
Dr. Carl Reynolds accepting from Richard Reynolds a check that established a major venereal disease control program
in North Carolina.
to develop a VD control program. Z. Smith Reynolds, the youngest
son of Winston-Salem tobacco manufacturer R. J. Reynolds, had died
mysteriously in 1933, and his siblings established the foundation as a
memorial. Mary Reynolds Babcock, Smith's sister, had strong ties to the
American Social Hygiene Association, and she apparently directed the
foundation's interest toward VD. The $100,000 the foundation allocated
in the first year provided the stimulus for a campaign by the State
Board of Health that lasted through 1946.^°
The school's involvement in the campaign began a few years later
when the State Board of Health allocated $17,500 for a professor of
syphilogy and a staff to conduct research on venereal diseases. The
school conducted a national search and selected Dr. William A. Fleming
for the professorship. With a B.A. and M.D. from Vanderbilt University,
where his father was a well-known southern historian, Fleming had
gone on to The Johns Hopkins to study and conduct research on
syphilis.^'
Shortly after Fleming came on board, the Rockefeller Foundation
contributed additional funds for a major epidemiological study of VD.
The school selected Dr. John Wright, an M.D. from Vanderbilt Uni-
38
versity and a recent M.P.H. from The Johns Hopkins, to head the project.
Initially the study targeted the Orange-Person-Chatham County Health
District, but Wright soon realized the need to include a more urban
area and added the Durham City-County Health Department. The
project's goals included establishing the prevalence of syphilis in the
area, gathering data to determine incident rates and trends, identifying
the contacts of infected people, and developing programs to treat the
afflicted. Wright and his staff used a number of innovative techniques.
They collected data from a variety of sources and entered it on McBee
keysort cards for analysis, the first application of computer technology
at the school. Film strips provided an alternative method of instruction
for patients, and recordings of nurse-patient interviews helped train
public health nurses. ^^
These efforts to control and eradicate VD increased the demand
for public health nurses and soon led to the establishment of the De-
partment of Public Health Nursing. Nurses played a key role in the
delivery of health care to the public, but from the beginning they had
been excluded from schools of public health. Nurses in North Carolina
expressed great interest in public health training when the division
opened in 1936, and the North Carolina State Nurses' Association asked
the university to develop a program in public health nursing. Rosenau
A public health nurse in New Bern, North Carolina, gives instructions on ways to
eradicate rats.
39
recognized the need for such a program but said he lacked the personnel
and resources to make it possible. By 1940 the addition of new faculty
and the support of the State Board of Health changed all that.-^^
In that year State Health Officer Carl Reynolds requested an out-
line for a course in public health nursing. The School of Public Health
submitted a plan that drew on existing faculty and called for the addi-
tion of two professors. Reynolds sent the proposal to the Public Health
Service and the Children's Bureau, a branch of the U. S. Department
of Labor that served as an advocate for the needs of children and
mothers. Both agencies responded favorably. "We believe that training
for public health nursing should be an integral part of a School of
Public Health and with our setup we have an opportunity to establish
this useful enterprise on a plane that will be without peer anywhere,"
wrote Rosenau. "There is at present a dearth of trained nurses for public
health service, and a career in this field opens a new frontier for which
there will be a growing and continuing demand."^'*
Among the people suggested to head a Department of Public Health
Nursing was Ruth Hay, then on the faculty of the University of Cali-
fornia at Berkeley. Writing to Dr. Rosenau, she expressed great interest
in the possibilities at Chapel Hill. "The inclusion of training of all
public health personnel in one school," she wrote, "is a plan that I have
considered for some time as an ideal set-up." Rosenau offered her the
job. Ruth Hay brought many years of experience as a teacher and a
practicing public health nurse to the job at Chapel Hill. A native of
Ohio, she received her B.A. from Ohio Wesleyan University and her
M.S. from Western Reserve. Since 1931 she had taught public health
nursing at Vanderbilt, Western Reserve, and at Berkeley. She recom-
mended a colleague from Berkeley, Margaret Blee, to fill the other
position in the department. ^^
In 1942 the presence of a well-qualified educator provided the
stimulus for a second new program. In the fall of 1941, Dr. Lucy S.
Morgan, a health educator with the Public Health Service, joined the
staff of the State Board of Health as part of a "lend-lease program." The
daughter of Harcourt A. Morgan, a former president of the University
of Tennessee and at the time chairman of the Board of Directors of the
Tennessee Valley Authority, Lucy Morgan possessed a keen awareness of
the health problems of the South and a great deal of experience in
addressing them. Before receiving her Ph.D. in public health from Yale
40
Ruth Hay anJ Margaret Blee shortly after they began
teaching at Chapel Hill.
in 1938, Morgan taught school and worked as a health educator in
Tennessee. After graduating, she developed a community health educa-
tion program for the city of Hartford, Connecticut.^^
Morgan joined the Public Health Service in 1941, which immedi-
ately "loaned" her to the North Carolina State Board of Health. State
Health Officer Carl Reynolds assigned Dr. Morgan to the Cumberland
County Health Department in Fayetteville with specific instructions to
counter the increase of prostitution around Ft. Bragg. Wartime created
numerous health problems for towns near military bases. There were
housing shortages, a constant coming and going of civilians and soldiers,
and an upsurge in venereal disease. Dr. Morgan applied imaginative
community-organizing techniques to public and private health problems.
By working through local black and white women's groups and relating
the educational program to the war effort, she helped rally the com-
41
Campaigns designed by
health educators in
North Carolina on loan
from the Public Health
Service.
munity around issues such as nutrition, venereal disease, sanitation,
and tuberculosis.^^
Soon more Public Health Service educators arrived in North
Carolina, and similar programs developed in other cities. The success of
these health educators spurred Dr. Reynolds to ask the School of Public
Health to train some North Carolinians. The State Board of Health
offered fellowships to three young women, and in the fall of 1942 they
enrolled at Chapel Hill. At the same time, Dr. Rosenau requested the
services of Dr. Morgan to develop a curriculum in health education
and assist with the instruction of students. "We have already made a
modest start in Public Health Education," Harold Brown wrote in re-
questing a faculty appointment for Lucy Morgan, "but this can be
greatly augmented and made outstanding by a person of Dr. Morgan's
ability and experience."^^
Lucy Morgan produced a whirlwind of activity wherever she went.
Thanks to twenty scholarships from the W. K. Kellogg Foundation, the
first class of public health educators had twenty-five students in the
spring of 1943. Morgan immediately put the students to work, with
courses ranging from malariology to public speaking. Like nursing, health
education had a somewhat experimental curriculum for the first few
years. For instance. Dr. Morgan initially planned field training for the
summer months, only to discover that vacations and the weather pre-
vented quality interaction between the students and local practitioners.
The next year the students took their training in the spring and spent
the summer taking courses in Chapel Hill. Dr. Morgan did not limit
the students' education to classroom instruction and field training. She
42
instituted a speakers series that brought in some of the most respected
people in the field of public health.^'
The addition of departments of public health nursing and educa-
tion had not been part of Dr. Rosenau's original plan for the school.
Like the men who guided the schools at The Johns Hopkins and Harvard,
he envisioned a more scientific orientation for the program at Chapel
Hill. But like so much that happened over the next fifty years at the
school, demand for the service and the availability of resources brought
about unintended change. The two new departments set a pattern for
the future in another way as well: like most of the practice-oriented
disciplines that would eventually be included in the curriculum, public
health nursing and public health education were dominated by women.
Dr. Margery Lord had broken the gender barrier as a student in 1940,
and the presence of Ruth Hay, Margaret Blee, Lucy Morgan, and in
1945 Eunice Tyler made the school a unique enclave of female academics
on the Chapel Hill campus.
Relationships with faculty at the university proved difficult for the
pioneer women. "They thought next to nothing of women, " Lucy
Morgan remembered, "and when we first got here, we weren't allowed
to join the faculty club [even though] the only thing they did was go
to the Carolina Inn for lunch and maybe they told jokes they thought
we couldn't hear." In discussions with early civil rights groups Morgan
used to pull out her Men's Faculty Club card — after they let women
join— as proof that she belonged to "the most discriminated group in
the world— women." "Even at Chapel Hill," she would add, "that great
liberal institution." The situation at the school, however, proved quite
43
mi
Troop departures in Fayetteville in 1942.
different. "There was no question with Rosenau [and later McGavran]
about women," Morgan remembered. "We would gather in Dr. Rosenau's
office and we would just talk over whatever it was. [Women] were
treated exactly alike, your opinions were asked. We had a democratic
institution."^"
Despite the success of nursing and health education. World War II
imposed severe hardships on the school. The armed forces and the
Public Health Service needed men and women with public health ex-
perience, so fewer people applied to the graduate programs. In addition,
certain members of the faculty felt they could contribute most to the
war effort by working outside the university. H. G. Baity spent part of
the war in Brazil working for the Institute of Inter-American Affairs
(the predecessor of the Agency for International Development), Harold
Gotaas joined the same organization in Washington in 1942, and Roy
Norton left for the army.
Determined not to let the school founder, Rosenau began looking
for students to fill the classes. He was aided in this effort by Dr. Harold
Brown, who was appointed dean of the school in 1941. The armed
forces provided one obvious source of students, and the School of
Public Health instituted short-term training for military men and women.
The university also authorized the school to allow undergraduates with
certain prerequisites to take their fourth year at the school and receive
a B.S. in Public Health. Upon entering the armed forces, these grad-
uates could be assigned to public health work. Short courses for public
45
health nurses, dentists, sanitarians, and health educators filled out the
schedule.^'
During the war, the School of Public Health also began receiving
students from outside the United States. The International Health
Division of the Rockefeller Foundation, the Commonwealth Fund, and
the Pan American Sanitary Bureau each made scholarships available,
primarily for students in sanitary engineering. Luis Mantilla from Lima,
Peru, and Tarik Bilginer from Istanbul, Turkey, were the first students
on Rockefeller fellowships to attend.
Over the next two decades, hundreds of foreign students would
take classes and receive degrees from the school. Virtually all of the
faculty during that time would serve as consultants to health agencies
in developing countries. Dr. Harold Gotaas, former faculty member at
the school and later president of the Institute of Inter-American Affairs,
offered an explanation for this development, which put the public
health movement at the forefront of American expansion in the
postwar world:
The activities of the Inter-American Cooperative health program
directed toward the control and reduction of infectious diseases and
toward the elevation of health standards in the hemisphere serve in
the interest of economic and efficient development of resources.
With this development will come purchasing power and a higher
standard of living which are necessary bases for the extension of
trade and the support of commerce.
Cooperative public health had already proven an efficient means
for cementing friendship, understanding, and cooperation in the
hemisphere. It is believed that public health will continue to develop
as an instrument of neighborly friendship and for the demonstra-
tion and preservation of the democratic way of life.^^
The comings and goings of faculty and students became common-
place during the war. Samuel Hopper and Brewster Snow taught sanitary
engineering for a period. Dr. John Larsh joined the faculty in 1943.
But the most unsettling departure was that of Dr. Harold Brown, who
resigned as dean to go to Columbia University. Rosenau had groomed
Brown as his replacement, and with Brown's promotion to the deanship
everything seemed to be in place. But the New York school offered
more money and better research facilities. Rosenau reclaimed the title
of dean, but the search began almost immediately for a replacement.
46
Elizabeth L. McMahan {left)
and A. Helen Martikainen
(right) at a journal club
meeting. McMahan was a
student and later a faculty
member of the Department
of Public Health Education.
Martikainen was director of
Health Education for the
State Board of Health before
becoming the first chief of
health education for WHO.
Students from outside the United States, like these health educators from Puerto Rico, became com-
monplace at the school during the 1940s.
47
A public health nurse visits the home of a family in South
Carolina in the 1940s. Training these front-line practitioners
was an important part of the School of Public Health's
mission in the 1940s.
North C^arolina College for Negroes President
James E. Shepard
48
c:
'Mr
DOCTw..^ ■^^ THE
iTlY POI ^"" ^C
The prospect of peace buoyed the spirits at the school during the
spring and summer of 1945, and the staff began looking expec-
tantly toward the future. Dr. Rosenau expressed that enthusiasm
upon his return for the fall semester. "I am just back after a bully vaca-
tion," he wrote a friend, "and I am in a hot spot trying to hold down
the lid. Our school is booming and prospects are glamorous."'
The world had changed dramatically during the previous four years.
Fascist movements in Germany, Japan, and Italy had been defeated; the
Soviet Union had become a world power; and the nineteenth-century
colonial empire had come apart. The United States had emerged from
the war virtually unscathed, determined to play a leading role in world
affairs. The United Nations had been created, along with agencies such
as UNESCO, UNICEF, and WHO.
On the home front, the federal government assumed unprecedented
responsibility for the social and economic life of the country. In public
health the pendulum swung even further away from private funding, as
the Public Health Service took over many of the functions once per-
formed by philanthropy. Congress considered legislation on national
health insurance and federal support for the nation's hospitals. In North
Carolina, medical educators and politicians debated the merits of a
four-year medical school at Chapel Hill and an expanded system of
hospitals for the state.
The School of Public Health's first postwar initiative involved the
creation of a Department of Health Education at the North Carolina
College for Negroes (NCC) in nearby Durham. Chartered in 1910 as the
National Religious Training School and Chautauqua under the leader-
ship of Dr. James E. Shepard, NCC had become one of the nation's
49
outstanding black colleges by the 1940s. After meeting Dr. Rosenau,
Shepard wrote the General Education Board about the need for "trained
health personnel. . .for the Negro people" and his idea for establishing
a school of public health for blacks at NCC. The board took preliminary
steps in that direction by supporting a summer institute for teachers
and health workers and later establishing a student health service at
the college. But Shepard pressed for at least a graduate program in
health education. Finally, with Rosenau's support, Dr. Lucy Morgan
agreed to assess the feasibility of such a program.^
When the Mississippi State Board of Health asked the School of
Public Health to train eight black students in 1945, Shepard and Rosenau
decided to go ahead with the program at NCC. A curriculum modeled
after the one at Chapel Hill quickly took shape, with UNC professors
providing the instruction. "They were willing to teach," Lucy Morgan
remembered, "and it paid nothing but a pittance, but they went over
The first public health education class, North Carolina College for Negroes, 1945-46.
50
and taught the same classes that they did at Chapel Hill." John Larsh,
for instance, taught his introductory course, "Parasitism in Human Dis-
ease." "They were very good students," he recalled. "Howard Barnhill,
[Howard] Fitts, were very eager." Gradually students trained at NCC
took over some of the teaching responsibilities.^
The Department of Public Health Nursing assisted in a similar
program beginning in 1946. North Carolina College had a nursing
program, so Ruth Hay and Margaret Blee served as consultants and
taught courses in public health nursing. The program continued until
1956, and Chapel Hill professors taught a course in public health
nursing at NCC until 1963.''
Dr. E. W. McHenry of the School of Hygiene at the University of
Toronto visited a class at NCC in the spring of 1946. "The ten persons
in the class," he reported, "gave a very fine impression. . . . This project
to provide well-trained health educators is one of the most hopeful
undertakings I have seen in the South''^
The black community certainly needed health educators, as well
as doctors, hospitals, and health facilities of all kinds. Life expectancy
was much lower for blacks than whites, and infant mortality rates were
much higher. Nutritional problems abounded. The over one hundred
health educators trained at NCC between 1945 and I960 could not
negate the years of neglect. But the lessons they learned and applied in
their local communities helped gradually to improve the health status
of the black population.^
The program at NCC was a progressive step in other ways. Jim
Crow still reigned in the South, even in Chapel Hill, the bastion of
southern progressivism. There was little effort on the part of the uni-
versity or its faculty to reach out to blacks. "Public health was upsetting
the hell out of everything," John Larsh remembered. "Those people in
South Building [the university administration], they couldn't understand.
You weren't supposed to do things like that. It was frowned upon. But
in public health we've always believed in helping people, and training
people to get out there and do things, and you don't do that by being
very conservative."^
In addition to providing the students with classroom opportunities
NCC could not afford, the UNC-NCC Department of Public Health
Education promoted interracial cooperation on a limited scale. Lucy
51
Milton J. Rosenau with public health education students shortly before his death.
52
Morgan recounted the efforts to bring black and white students together.
"They had to be introduced to each other. They had never done that
before. What we did was to have a journal club, and we met first over
there [Durham] and then over at Chapel Hill. At that time you were
not supposed to eat with blacks. So we always had refreshments at the
meetings. We sent them together to the field, and then we had open
houses when the people came in from the field, black and white together.
Then it got bitter for a while, and we used to pull down the shades
sometimes when we had meetings in Chapel Hill."^
Operating within the framework of "separate but equal," these efforts
by public health educators highlighted the absurdity of the Jim Crow
system. Yet at the same time the program's existence shored up a seg-
regated system of higher education that remained blatantly unequal.
For fifteen years NCC maintained a separate program. Only in 1960, as
the civil rights movement pressed for an end to segregation, did the
School of Public Health admit its first black students.
As the school began tackling some of the many health problems
that faced the South in the postwar period, it lost its founding director.
On April 9, 1946, at the age of seventy-six, Dr. Rosenau suffered a
heart attack and died. In some respects Rosenau died at the height of
his career. Only the year before, he had been elected president of the
American Public Health Association, the final (and long overdue) tribute
to one of the great leaders of the public health movement. Dr. Rosemary
Kent, a student in Rosenau's last class and later a professor at the
school, recalled the dean's last day in the classroom.
Probably, short of construction blasts, nothing has ever rocked the
building across the street [MacNider Building] as did the unaccus-
tomed applause from the auditorium the day Rosenau closed the
course in epidemiology in December 1945. On, on and on it thun-
dered and rolled. Overcome at last. Dr. Rosenau turned to the
stairs at the front of the room and slowly, quietly started down the
long two flights to his office. And still the applause followed him
every step of the way and could be heard by the staff on the ground
floor Only then, with damp eyes, did the class depart. . . . He knew,
as did somehow the students upstairs, that he had just delivered
his valedictory.'
Rosenau's death created many problems for the school and exposed
the fragility of the enterprise. Still, the transition had been expected.
53
When Harold Brown resigned as dean in 1943, Rosenau had begun
searching for a suitable replacement. He and Frank Graham seriously
wooed General James S. Simmons, chief of preventive medicine in the
office of the surgeon general. A native North Carolinian, Simmons liked
the idea of moving to Chapel Hill but felt he was too old to set to
work at a school that lacked financial security. Harvard also desired his
services, and that school's endowment and the promise of more Rocke-
feller money enticed him to Cambridge. '°
After Rosenau's death, John Wright and H. G. Baity assumed
responsibility for running the school and looking for a new dean. But
in the meantime there was much work to be done. Returning soldiers
filled the classrooms, and replacements had to be found for the staff
members who did not return after the war.
The school's first major step in the postwar period involved the
establishment of a Department of Nutrition. Dr. Rosenau had begun
the plans shortly before his death. "It is scarcely an overstatement," he wrote
the General Education Board's A. R. Mann, "to say that nutrition is
public health problem number one in the southern section of our
country, and it is my opinion that the time has arrived to set up a
Department of Nutrition in the School of Public Health." The decision
by the Rockefeller Foundation's General Education Board to fund such
a department made it possible for Wright and Baity to bring Rosenau's
plans to fruition."
The school hired Dr. A. Hughes Bryan to head the new Depart-
ment of Public Health Nutrition. The son of a sugar chemist with the
U. S. Department of Agriculture, Bryan studied chemistry at Harvard
College and received his M.D. at Harvard Medical School. He taught
and did research at the University of Chicago Medical School before
joining the Public Health Service during the war. Dr. Bryan's most im-
mediate task in his new assignment was to assemble laboratory equipment
and plan renovations for his new home, Building C, a temporary struc-
ture located on the north side of MacNider Hall. ^^
Meanwhile, the search for a dean continued. After another can-
didate declined an offer to head the school, H. G. Baity issued words
of warning to President Graham and Chancellor Robert House. The
school's poor standing relative to the other schools of public health was
undermining its recruitment efforts:
54
A. Hughes Bryan, first
^ hair of the Department
of Public Health Nutrition,
at work in his laboratory.
All of our eight competitors are institutions with great resources,
stabilized budgets, excellent existing staffs, adequate physical facilities
and good salary schedules with guaranteed tenure and attractive
retirement allowances. In other words, they are going concerns
which offer promise and opportunity.
Here at Chapel Hill we can offer none of these things — only hope
for the future and an abundant opportunity to better the health of
our southern region. We have no stabilized budget, in fact no
guarantee of existence beyond the coming year. We have little
existing staff left to inspire newcomers. We have a low salary schedule,
and have not been able to offer tenure. We are already so crowded
in our physical facilities. . .that we are not only unable to accom-
modate the research activities of new staff members . . . , but we are
actually unable to provide office space for the people we are trying
to employ.
If we cannot build a staff of first-rate people in key positions it
would be better, I think, to discontinue the school.'^
Not long after that, Baity began discussing the deanship with Dr.
Edward G. McGavran, head of the Department of Public Health and
55
H. G. Baity, Edward G. McGavran, and John Wright working on the school's annual report
Preventive Medicine at the University of Kansas Medical School. The
job interested McGavran, but like the other candidates he found the
lack of state funding to be a serious obstacle. After much discussion
and persuasion, the North Carolina General Assembly agreed to provide
token support for the school, the university allocated a limited number
of tenure positions, and the Public Health Service agreed to supplement
the new dean's salary. In April, 1947, McGavran accepted the univer-
sity's offer. Baity was ecstatic. "I cannot begin to tell you how happy all
of us are [at] the news that you have really decided to come with us as
dean. . . . At long last I feel that we are on a solid fiscal foundation and
are in position to establish ourselves among the leading public health
institutions in the country."''*
Like Rosenau, McGavran possessed extensive training and wide ex-
perience in public health. McGavran was born in India, where his
parents were missionaries. An aunt who lived with them served as the
town's only medical doctor, and her efforts to meet the almost
unlimited needs of the community influenced his decision to go into
56
medicine and public health. The family returned to the United States
and settled in Indianapolis, where McGavran attended high school
and college. After graduating from Harvard Medical School in 1928,
McGavran spent four years in private practice before returning to Har-
vard to earn a master of public health degree. From 1934 to 1946 he
served as a public health officer, first as director of the county health
department in Hillside, Michigan, where he also administered the Kellogg
Foundation project in field training, then as director of a training cen-
ter in West Virginia, and finally as health commissioner of St. Louis
County, Missouri. Shortly before taking the job at Chapel Hill, he had
joined the faculty of the University of Kansas. ^^
McGavran saw himself primarily as an administrator whose job
was to create an atmosphere where faculty, staff, and students could
work and learn together. He described his philosophy in this way:
The first step in accomplishing these objectives was to develop an
organizational pattern within the faculty and a school philosophy.
This was done by weekly formal staff meetings of the entire faculty
with a carefully prepared agenda and subsequently approved minutes.
All policy and most administrative matters were discussed in detail
with the entire faculty and majority vote ruled. Time was set aside
at each meeting for complete informational exchange between de-
partments. Ad hoc committees were formed and appointed to study
many specific problems, with the eventual development of standing
committees within the faculty. The most desirable time of the week
was set aside for these staff meetings; and neither classes nor com-
mitments were permitted on Monday afternoons. These were strictly
"Executive Sessions'— no holds were barred. Full expression and the
privilege of dissension were encouraged.
It thus became evident from action rather than by word alone that
the new administration of the school was a democratic adminis-
tration, informal, but firm in its purpose: to operate the School of
Public Health as a team of professional equals who would determine
policy, instruct the dean, and back him wholeheartedly in carrying
out the school's wishes and desires.'*
McGavran's presence had an immediate impact on the school. By
the end of his first year, nine new faculty positions had been created,
and the budget for research had increased from $75,710 to $230,710.
Most of that growth came from two sources: the Kellogg Foundation's
support for a Department of Field Training and the Public Health
57
58
Service's decision to move its Syphilis Experimental Laboratory to the
school.
Field training had long been a staple of public health education.
At the school, public health nurses and educators conducted field work
in the spring quarter as part of their degree requirements. But soon
after McGavran's arrival, the school submitted a proposal for a much more
ambitious program to the W. K. Kellogg Foundation, where McGavran
had worked earlier. Field training was crucial to McGavran's evolving
notion of public health. He compared it to the clinical portion of
medical education; to him, field training was equivalent to bedside
practice. The proposal called for establishing a field training station in
the Orange-Person-Chatham-Lee District, as well as improving local
training sites throughout the South. This plan included short courses,
in-service training, supervised field experience, apprenticeship training,
and residency training. The Kellogg Foundation provided the initial
funds for the program, and the State Board of Health provided addi-
tional money and personnel.'^
Dr. William P. Richardson assumed the duties of head of the De-
partment of Field Training on July 1, 1948. A graduate of Wake Forest
College and the Medical College of Virginia, Richardson proved an
ideal person for the job. He had rich experience as a local health officer
(he had served as head of the Orange-Person-Chatham District Health
Department from 1936 to 1944) and on the staff of the State Board of
Health. In addition, the Public Health Service assigned a sanitary
engineer and a public health nurse to the department.'^
The school also became the site of the principal research laboratory
of the Venereal Disease Division of the Public Health Service. In 1945
Dr. William L. Fleming resigned as director of the Reynolds Research
Laboratory, and a year later the Z. Smith Reynolds Foundation with-
drew its funding for venereal disease research in order to increase its
contributions to Wake Forest College, then in the process of moving
from Wake Forest to Winston-Salem. Dr. Harold Magnuson of the Public
Health Service replaced Fleming, and the university, the State Board of
Health, and the Public Health Service stepped in to support the labora-
tory. Meanwhile, The Johns Hopkins closed its Laboratory of Experimental
Therapeutics, and the Public Health Service decided to relocate some
of the laboratory's staff, equipment, and functions to Chapel Hill. The
university agreed to construct a building to house a newly designated
59
Orange Person Chatham^
DISTRSCT
HEAITH MPARTMENT
■-m^
Public health educators from
the North Carolina College for
Negroes and the University of
North Carolina at the field
training center, 1946.
Syphilis Experimental Laboratory. The closing of another Public Health
Service laboratory in 1949 brought additional equipment and personnel
to Chapel Hill. While the Department of Experimental Medicine's
primary concern was venereal disease, its research often had much
broader applications. "We find ourselves engaged in a wide variety of
projects," Magnuson wrote Dean McGavran, "involving chemotherapy,
antibiotic therapy, bacterial metabolism and physiology, protein chemis-
try, and other areas that lie outside a narrowly defined venereal disease
field."i9
There was much excitement over all the changes at the school,
but the daily demands of the classroom, the laboratory, and the field
station kept everyone's feet on the ground. The school's most immediate
problem was that it had no place to put the new people and programs.
In a plea to Chancellor House to consider a new public health building
as the university's number one priority, McGavran described the prob-
lems. "One department is housed in the old Water Works Building, half-
way across the campus. Four temporary buildings have been put up
and are full to overflowing. . . . Many workers are crowded into a single
60
• 9 "S- !P^^ ■■ Will (■
Many of the school's offices, classrooms, and laboratories were outside MacNider Hall in the 1950s.
Above, the Department of Health Education's office in the old Water Works building on the main
campus; belou.; the temporary buildings to the north of MacNider.
61
62
room or single laboratory meant for one person." Not only were present
operations threatened, but the future of the school as well. Without
additional space, there could be no expansion of the student body, no
increase in foundation and federal funding. "The era of health interest
and public support is here," the dean wrote House, "and we shall either
be on the bandwagon or see the parade go by with other southern
institutions taking the lead in public health development."^"
The school's inability to secure funds for a new building would
plague McGavran for the next decade. In part, the difficulty stemmed
from the School of Public Health's multiple commitments. Was the
school's primary constituency the university, the state of North Carolina,
the southeastern region, the United States, or the foreign countries
that increasingly sought its help? To McGavran, the health agencies
that supplied student scholarships were the primary constituents. North
Carolina's State Board of Health was one of these, but so were those of
other southern states, foreign countries, and various federal agencies.
The school saw itself as a regional, national, and international center,
but unlike The Johns Hopkins and Harvard it had no endowment and
so depended on the state for funds, especially for physical facilities. But
the legislature was unwilling to use scarce resources for non-North
Carolina students.^'
The fact that the rapid growth of the school also coincided with a
major expansion of medical services at the university also presented
problems. In 1944 Governor J. Melville Broughton, at the urging of
the North Carolina Medical Society, appointed a commission to study
the hospital and health needs of the state. North Carolina's dubious
distinction of having the highest rejection rate for draftees during the
war prompted the decision, but it was also part of a nation-wide effort
to increase the availability of hospitals. The commission called for the
establishment of a four-year medical school at the university, the building
of a teaching hospital in connection with the medical school, and the
creation of hospitals and medical centers in parts of the state with in-
adequate facilities. Although many people supported the commission's
recommendations, powerful figures in the legislature and the medical
community opposed all or part of the report. Some felt the existing
four-year schools at Duke University in Durham and Bowman Gray
Hospital in Winston-Salem adequately met the state's needs. Others
argued that such a school belonged in a major city, rather than on a
college campus. Still others opposed the state-sponsored proliferation of
63
ITS ALL UP TO YOU
(to make flolik wmhajo.\m,
Gooonm
The Good Health Campaign was
part of the post-World War II drive to
upgrade medical facilities and improve
the health of North Carolinians. The
public relations effort, as represented
by this song, were reminiscent of the
State Board of Health's campaigns in
the 1910s and 1920s. Department of
Public Health Education students
Ralph Boatman, Maisie Bookhardt,
Mary-Elizabeth Gruwell, and Harriet
Hylton Barr work on campaign.
64
local hospitals. For the next few years politicians, university officers,
and health officials debated the merits of the plan. In the end, the
advocates of the North Carolina Medical Care Commission's recom-
mendations prevailed, and in 1947 the General Assembly appropriated
funds which, combined with federal support under the Hill-Burton Act,
allowed for the building of a hospital at Chapel Hill and the expansion
of the Medical School. ^^
Within a few years of these decisions, Chapel Hill had become a
large regional medical center. The university added the Schools of
Dentistry and Nursing and established a Division of Health Affairs to
coordinate these new programs, as well as the Schools of Medicine,
Pharmacy, and Public Health. Dr. McGavran strongly supported bringing
the schools together in one administrative unit, hoping that such a
move would foster cooperation between medicine and public health. He
also agreed to serve as acting administrator of the division from March,
1949, until July, 1950. In his absence, John Wright served as acting dean
of the School of Public Health. Finally, Dr. Henry Clark, Jr., took the
assignment as head of the division and McGavran returned to the
dean's office."
These developments generated much discussion about the health
needs of the state's citizens, but they had limited impact on the public
health movement. The trajectory of postwar spending on health in the
state and in the university clearly favored the medical profession and
the hospital industry. The medical profession's ability to control post-
war spending on health stemmed in part from public health's lack of a
politically powerful constituency. Although efforts to eradicate commu-
nicable diseases, preserve clean air and water, and dispose of wastes
benefited everyone, politicians often viewed public health as a welfare
program for the less fortunate members of the society. People who ben-
efited most visibly from public health services— blacks, the poor, the
elderly, children — had little clout in the halls of power. ^'*
The school also operated in a very different political environment
from that of the early days of the public health movement. In the past,
philanthropical foundations viewed a healthy population as good for
the business interests they represented. Progressive Era and New Deal
reformers sought to provide a safety net for those who lacked access to
doctors and hospitals. But efforts to maintain or expand New Deal
programs met stiff opposition after the war. President Harry Truman's
proposal for national health insurance failed in Congress. The public
65
health movement appeared at loggerheads with the conservative drift of
the country. ^5
Dean McGavran hoped that legislators would see public health as
an alternative to national health insurance. "It takes no political prophet,"
he wrote, "to see that the postwar conservative government will shy
from the 'radical' medical care legislation and appropriations but cannot
avoid fulfillment of some of its promises by public health and hospital
support far in excess of anything heretofore proposed." McGavran was
right about support for hospitals, but public health would have to wait.^^
Despite these difficulties, the school continued to sink its roots
deeper into the university community and reach out to the people of
the state. "There is about the School of Public Health an interesting
atmosphere of confident assurance," noted an official of the Common-
wealth Fund. A major reason for this buoyancy was the creation of
new departments and the arrival of new faculty members in the late
1940s and early 1950s, some of whom would play major roles in the
future of the school and the university. ^^
Dr. Cecil G. Sheps joined the faculty as associate professor of
public health administration in the fall of 1947. A native of Winnipeg,
Canada, Sheps received his M.D. from the University of Manitoba and
his M.P.H. from Yale University. His parents were Jewish socialists from
the Ukraine, who immigrated to Canada after the 1905 revolution.
Sheps initially considered law and politics as the proper sphere in which
to fight for his notions of social justice, but a lecture on the triumphs
of public health convinced him otherwise. "I was inspired by that lec-
ture," he remembered, "and decided that I would go into medicine, that
I could achieve my social objectives through medicine." After a few
years of general practice, a stint in the Canadian Army, and a job in
public health in Saskatchewan, Sheps accepted a fellowship to study
medical care administration at Yale. From there he ventured to Chapel
Hill to teach a summer session in epidemiology and biostatistics. Sheps's
army experience in venereal disease control attracted the attention of
John Wright, and Wright offered Sheps a job. Wright and Sheps began
sifting through the data collected by the venereal disease project and
published their findings in a number of papers. -^^
A future dean of the school, Dr. Bernard Greenberg, joined the
faculty as chairman of the newly organized Department of Biostatistics
in 1949. The lack of such a department had marked a serious weakness
66
^
Bernard G. Greenberg
in the school's curriculum. Over the years various people had taught
courses in biostatistics, and in 1945 the school began the search for
someone to head a department. Greenberg established ties to the school
in the fall of 1946, taking Dr. Baity's course in public health sanitation
while a graduate student in experimental statistics at North Carolina
State College in Raleigh. ^^
Biostatistics filled a critical hole in the school's offerings, but it
took a while for faculty members to get over their initial skepticism
about its relevance for their work. The Department of Public Health
Nutrition provided Greenberg's first collaboration on a project studying
the relationship between the physical measurements of school children
and their diet. Before long, statistical methods became a vital tool in
public health investigations.
The school established a Department of Maternal and Child Health
in 1950 with funds from the U. S. Department of Labor's Children's
Bureau. Since the passage of the SheppardTowner Act in 1921, the
Children's Bureau had aided programs designed to reduce maternal and
infant mortality. The expansion of these programs in the postwar era
increased the demand for professionals in the field. Dean McGavran
selected Dr. Sidney Shaw Chipman to head the department. A Canadian
by birth, Chipman received his M.D from McGill in 1928 and his
M.P.H. from Yale in 1947. The maternal and child health team consisted
of a physician, a nurse, and a medical social worker, and the Children's
Bureau provided funds for all positions. In addition to Dr. Chipman,
Jean Rebentisch joined the department in 1950 as associate professor of
maternal and child health, and in 1953 Geraldine Gourley came on
67
g«JjOi —
i
Sidney Chipman
board as associate professor of medical social work. The department
developed a curriculum for students specializing in maternal and child
health and more generally for all students in the school. ^°
The school had long been interested in providing instruction in
mental health for its students, but lack of funds limited course work to
a few lectures by visiting instructors. In 1952 a grant from the Public
Health Service allowed the school to create a Department of Mental
Health and to hire Dr. Roger Howell as its head. With Dr. Howell's
arrival, students received more in-depth instruction in this area of growing
concern. Howell also began developing a curriculum to train adminis-
trators for mental health centers.^'
By 1952, all of the present-day departments had been organized.
Rosenau, Baity, and McGavran had established a structure that fit the
mission of the school and the personalities of the faculty. McGavran
now had a tight-knit team of professionals ready to tackle the region's
problems.
McGavran himself did much to create the sense of community
that characterized the school in those days. "I liked the spirit of the
68
69
whole thing," Rebecca Bryan, a student and later faculty member at the
school, recalled. "The very first week we were here the McGavrans had
all the student body come out to their house for a reception. Very
soon after that they began inviting us in smaller groups for Boston baked
beans and brown bread. We were really royally entertained." Members
of the faculty also invited students to their homes. "We were all wet
behind the ears," Bryan recalled, "so it was exciting and interesting to
be able to sit down and share with somebody else what was going on
in your state." ^^
Frances Gust, who joined the staff of the school as McGavran's
administrative assistant in 1950, saw McGavran's sociability as central
to his leadership style. "The students would marvel that Dr. McGavran's
memory was so good that at these dinners he would always shake hands
and call the students by name. But what they never knew was that he
would bring in a list of who would be there Friday evening. We would
get cards and if we could find a picture, we would put a picture on the
\
F
^
%'
Picnic at the McGavrans' in 1953.
70
card, and if not we would describe the person. He played with these
cards in advance and could say hello, how are you, and how are the
people back in Abilene, Texas. We always chuckled over this, but we
never gave away his secret."^^
The school accepted increasing numbers of students from foreign
countries in the 1950s, and McGavran wanted to establish the same
sense of community among them. For many, adjusting to life in small-
town America proved as difficult as the course work. Dean McGavran
asked Geraldine Gourley to develop an orientation program for these
students. "We got the sponsoring agencies to agree to the students'
coming two weeks before school started," she remembered. "For students
who needed it, we set up English classes. We had people who came in
and talked to them and we had social things. Then we had field trips
and went all over the state. We visited farms, sewage disposal systems,
dairies, schools, and health departments. They knew the resources of
the state better than the American students. They were much better
able to fit into the academic part of the school. They had this time to
get their feet on the ground."^'*
The highlight of this orientation program occurred in 1955, when
Zebulon, a town of about fifteen hundred, hosted foreign students from
Chapel Hill for a weekend. Civic clubs and church groups joined to-
gether for "THE WORLD IS COMING TO ZEBULDN." The high
school band and majorettes met the students at the town hall on Friday
afternoon. Banquets, a dance at the high school gymnasium, a visit to
a tobacco auction, and Cokes at the local drug store highlighted the
weekend activities. "The students were astonished," Gourley recalled, "at
seeing the mayor washing dishes and the head of the health department
serving with an apron on. One of the things that surprised them the
most was to find the farmers so prosperous and . . . people of authority.
In many of their cultures farmers were very poor."^'
Lucy Morgan created an equally strong esprit de corps among
public health educators. Public Health Education remained one of the
largest departments throughout the 1950s, and public health educators
were among the most visible members of the school for many years.
The philosophy that guided health educators defies simple explanation.
More than anyone else, Lucy Morgan provided the intellectual and
social rationale for the department, but other faculty members and
hundreds of students also left their mark. The first issue of the depart-
71
ment's publication, Health Educators at Work, defined the issues as the
editors Lucy Morgan and Eunice Tyler saw them. Although the United
States was the healthiest place in the world in which to live, serious
health problems remained. Medical science had the ability to alleviate
much of the suffering, but "ignorance, apathy, carelessness, and the
high cost of medical care" too often kept scientific advances from the
people. "Reducing this lag is one of the chief aims of health education,"
Morgan and Tyler explained. "Preaching the gospel of health is more
than advocating the use of toothbrush and vitamin chart; it is more
than teaching disease prevention. Health education implies a belief in
the right of every person to be as healthy and safe as science plus human
endeavor can make him and a belief in the necessity for informed
opinion to gain this end."^*
Morgan and her colleagues were most influenced by the teachings
of Lucy's father, Harcourt A. Morgan, and the well-known public health
advocate C.-E. A. Winslow. Harcourt Morgan grew up and received his
education in Canada but spent most of his life in the southern United
States, first as professor of entomology and horticulture at Louisiana
State University, then as president of the University of Tennessee, and
finally as chairman of the Tennessee Valley Authority. In the "Mooring
Harcourt A. Morgan
72
C.-E. A. Winslow, chairman of the
Department of Public Health at Yale
University School of Medicine.
Winslow's expansive vision of public
health, and especially his promotion
of the role of education, made him a
popular visitor to the school.
Eleanor Roosevelt addresses faculty and students in 1950. The school had the benefit of numerous presentations by
distinguished visitors over the years.
73
Don Ashton of the State Board of Health demonstrates the use of steel rat traps as part of a twelve-week short course
for sanitarians, directed by the school's Department of Field Training, 1951.
Lecture Series," which he delivered at the School of Public Health from
1943 to 1950, Harcourt Morgan elaborated his philosophy of the inter-
relationship among minerals, plants, and animals, and related his holistic
interpretation to social and economic as well as scientific problems. ^^
Despite the energy that seemed to drive the school in the early
1950s, significant problems remained. The school's annual report for
1951-52 listed five major needs: additional personnel, salary increases, a
larger operating budget, increased support from federal and state agencies,
and a new building. Personnel needs included administrative staff and
teaching assistants, as well as additional faculty to meet the growing
instructional demands. "Means must be found to provide more 'seconds
in command,'" McGavran noted. "We are not propagating our own
species. There is no replacement for too many of our key personnel."
But even if the school could obtain additional faculty positions, low
salaries prohibited the hiring of first-rate people, and there was a danger
that present staff would leave. "Present key personnel in public health
are not getting salaries commensurate with others of similar qualifica-
tion, training, and experience in the Division of Health Affairs and are
74
far below the 'market value' necessary to fill these positions," McGavran
complained. Equally pressing was the lack of funds to support the
school's expanding off-campus activities. "It should be borne in mind,"
McGavran argued, "that research in public health is largely field research,
and though it does not require the university to provide expensive
laboratory space and facilities, it does require equipment, secretarial
help, and travel, far beyond the amount necessary for research conducted
within the academic walls of the university. The 'field' is the laboratory
and the bedside for public health research and teaching. Failure to pro-
vide or effort to curtail reaching this 'field' and using this 'field' is like
locking the door of the laboratory, or closing the hospital and clinics
to medical, dental, and nursing education."^^
By the early 1950s, the frustrations associated with administering
an ever more diversified school and trying to win support for that
school in an increasingly hostile environment propelled McGavran into
the role of public health evangelist. Although his ideas had been jelling
for some years, they first saw print in 1953 in an article entitled "What
Is Public Health?" At the time, McGavran declared, no clear definition
of public health existed. "If this be true," he said, "it is no wonder that
with the changing times there continues to be increased misunderstanding
of public health by the organized medical profession; that there is apathy
and indifference to public health on the part of the public and appro-
priating bodies of government; that there is lack of direction and plan-
ning among public health workers themselves; and that the recruitment
and training of public health personnel lag far behind the needs in
every county and clime."^'
McGavran dismissed definitions that seemed too narrow— public
health is preventive medicine'— or too broad— 'public health is the well-
being of the people." The first definition intruded too often on the pre-
rogatives of the physician, while the second necessitated knowledge
beyond the possible scope of a public health practitioner. McGavran
insisted, instead, that public health was a distinct profession with a
"distinct body of knowledge that determines our competence without
limiting our objectives." Expanding the medical model, he identified the
community as the patient of public health, and the diagnosis and treat-
ment of that patient as the profession's goal. According to McGavran,
"Public health is, then, the scientific diagnosis and treatment of the
body politic." He described how this self-understanding affected public
health practice:
75
Acceptance of this answer calls for a democratic team of professional
equals. ... It immediately becomes obvious and essential that many
other professions with many other skills and knowledges must be
integrated into scientific public health to obtain a diagnosis and
plan of treatment for the body politic.
To diagnose community ills we must have knowledge of community
economy— the distinctive skills of the economist, a knowledge of
the social structure of the community, and the impact upon their
health practices of nutritional, . . .of recreational, religious, moral,
and ethical patterns. . . .
We must have knowledge and techniques of community organiza-
tion, of the power structure of that community, of the political
structure, of health laws and regulations, of attitudes that determine
acceptance or rejection of change and development. We must have
sophisticated knowledge of education and educational methods, of
mores and morals that affect the growth and development of com-
munity consciousness and community action.
We must have knowledge of community measurements, of the
demographic characteristics of our patient — the age, sex, racial dis-
tribution, and the intricate ways in which this affects our patient's
health; the biostatistical techniques of collection and analysis of the
data that can determine mass phenomena of disease and health;
the geographical base that determines isolation, transportation, and
resources.
We must have knowledge of sanitary science, the technical skills
that can determine oxygen demand or biologic balance under widely
varying circumstances. We must know the epidemiology of our
patient, the community, and develop techniques to assess the symp-
toms of community illness, physical or mental. . . .
All of this is nothing more or less than a scientific approach to
the diagnosis and treatment of the body politic — the history, the
physical examination, the tests, the analysis, the clinical judgment,
and the prescription for treatment. '^^
It was bad enough that the medical profession, political leaders,
and the general public misunderstood the role of public health, but
McGavran also felt that the school's faculty lacked a clear sense of the
movement's purpose. As a result the faculty spent the better part of
the 1953 winter quarter discussing questions relating to the role of the
school. "Before we can have a better understanding and appreciation
among others," McGavran told his colleagues, "we must set our own
76
\H
Dean Edward G. McGavran
house in order and have a better understanding and appreciation of
public health ourselves." McGavran posed the following questions for
the faculty to consider. "Are we a profession of public health or are we
only a correlation of other professions, functioning in an indefinite
area? Is there a body of knowledge, a discipline, which is distinctly
public health? Is our loyalty primarily to public health or to the basic
profession from which we have sprung? Can we define public health?"
In general the faculty agreed that public health had some common
body of knowledge, however nebulous. There was greater disagreement
over the issue of a professional identity, with most wanting to maintain
their identities as doctors, nurses, engineers, and so on. But in the
context of the times, McGavran faced an uphill battle. The conservatism
of the late 1940s and 1950s, the diversion of federal funds to the Korean
war effort, and the increasing focus on scientific solutions to health
problems limited the impact of his campaign. ■*'
"The Body Politic" became the rallying cry of a campaign to win
respectability for public health. Before his retirement in 1963, and after-
ward, McGavran spoke to many groups of people, and his speeches
almost always included a variation on this theme.
77
H. Bradley Wells of the Department of Biostatistics
78
r^hapter A
AND SOCIETY
The funding crisis in public health began to abate by the mid-
1950s. With the end of the police action in Korea, the federal
_ _ government once again channeled funds into scientific and
medical research. In the five short years between 1955 and 1960, the
National Institutes of Health (NIH) budget increased from $81 million
to $400 million. The successful Soviet launch of Sputnik stimulated the
race for space and freed even more money for science and education.
John Kennedy's election in 1960 focused attention on the problems of
the developing world, and public health forces played an important
role in new society programs such as the Peace Corps, the Alliance for
Progress, and the Agency for International Development.'
Frustrated in their efforts to win adequate support from North
Carolina sources, McGavran and his team set their sights elsewhere —
on other states, the federal government, and countries in the developing
world. Not everyone on the faculty shared McGavrahs community-
oriented philosophy of public health. But they were all ambitious, for
themselves and the school, and a spirit of reform permeated their efforts.
The school's first major venture outside the United States involved
assistance in establishing a sanitary engineering program at the National
University of Engineering (UNI) in Lima, Peru. It was the first of Dan
Okun's many successful educational advisory projects for the school.
Dr. Daniel A. Okun, who would establish himself as one of the uni-
versity's most dynamic faculty members over the next thirty years,
replaced H. G. Baity as head of the Department of Sanitary Engineer-
ing in 1955. Born in Brooklyn, New York, Okun dated his interest in
engineering to the time his father, an engineer for the city, took him
79
Marvin Granstrom {jar right) at the National University of Engineering, Lima,
Peru, 1956.
underground to see construction of the giant tunnel that would bring
water to New York City. He took an undergraduate degree in civil
engineering at Cooper Union and a master's degree at California Tech-
nical Institute before joining the Public Health Service, where he was
introduced to the field of public health in a series of lectures by, among
others, Dr. Edward McGavran. A stint in the army during World War II
took him to Latin America, New Guinea, and the Philippines where
he was exposed to the problems of the developing world. After the war,
he studied with Gordon Fair at Harvard University, earning an Sc.D.
in 1948. Okun worked for an engineering firm for a few years before
coming to Chapel Hill as a temporary replacement for Baity. Baity,
who had taken a leave in 1952 to work as the first director of environ-
mental health for the World Health Organization (WHO) in Geneva,
decided to stay in Switzerland, and Okun found teaching to his liking.-
80
Peru's water supply and waste disposal systems had not kept pace
with urban and industrial growth. Less than 20 percent of the popula-
tion received water from public supplies, and only a few larger cities
had sewerage systems for human wastes. As a result, thousands of people
suffered from diseases associated with contaminated food and water,
such as typhoid, infectious hepatitis, hookworm, and dysentery. Ulti-
mately, a massive program of education and public works would be
necessary to control these problems. But before that could happen,
Peru needed a trained core of sanitary engineers and related professionals.
In the past, most of the country's sanitary engineers had received grad-
uate training at North American universities, including the University
of North Carolina. In 1940 Peru's National University of Engineering
inaugurated an undergraduate degree program, but it was inadequate
for the country's needs. One problem, according to Okun, was the lack
of a "responsible core of full-time faculty." The UNI asked the Interna-
tional Cooperation Administration-Institute of Inter-American Affairs
for technical assistance. The Administration-Institute, in turn, asked
UNC's Department of Sanitary Engineering "to design, equip and supply
laboratories, train personnel, assist in teaching procedures, set up
extension courses and establish research."^
Dan Okun, Emil Chanlett, Marvin Granstrom, and Gilbert Kelso
each spent a semester in Peru, while Ed McGavran, John Wright, and
^
l"^-^?
^^:^,
.■.■V;:i-:^iroV^:S3i;E:
^
Dean McGavran displays
a rainbow trout he caught
in Lake Titicaca while
on a trip to Peru.
81
John Larsh went for shorter periods to help with their specialties. Dr.
Charles M. Weiss joined the department as a replacement for the faculty
member stationed in Peru. Although the project was designed to last
for only three years, a short period of time in which to launch an
educational program, Okun felt the project accomplished most of its
goals. The Peru project also proved valuable to the school's faculty.
"They learned that the introduction of United States techniques alone
is not enough. There must be a sympathetic discernment of the con-
ditions and the customs, the patterns and the problems, the prides and
the prejudices before sound progress can be made.""*
The Department of Public Health Education also undertook a
project far away from the Chapel Hill campus. In 1955 the department
contracted with the Public Health Service to develop a multipurpose
health education training program focused on the needs of American
Indians. The health problems of native Americans were quite serious at
the time, with many suffering from diseases long under control among
other parts of the population. The project targeted western New Mexico
Indian mothers and children in New Mexico who benefited from the health education programs
designed by the School of Public Health staff.
82
Health teaching in a Koranic school in Iran.
One of Lucy Morgan's efforts to
"widen the circle" of understanding
was her work as a consultant for
the World Health Organization.
Here, she is in Tehran, Iran, in 1956
with Akbar Moarefi, who received
a Ph.D. from the school.
83
and southwestern Colorado. Pueblo tribes predominated, but the area
also sustained Zuni, Apache, Ute, and Navaho peoples. Dr. Vaughn
Smith served as the project's first director and was later replaced by
Elta Mae Mast. Smith and Mast worked to develop health education
programs on the reservations and to recruit and train community health
workers who would stay on after the project ended. Faculty members
provided on-site consultation, but among the project's most valuable
resources were the foreign students who did their field training in the
area. Their assignment to the project reflected the faculty's belief that
the health problems facing American Indians closely resembled those in
the students' native lands. ^
Projects such as those in Peru and the Southwest— and there were
many similar ones over the years — helped the school realize its commit-
ment to better the health of all the world's peoples. Although it is
difficult to measure the impact of such short-term training programs on
the health of local populations, health education efforts among the
Zuni Indian population produced some demonstrable results. Diarrhea
was a major health problem, particularly among the newborn. In 1958
seven infants died of diarrhea. Health workers among the Zuni, along
with School of Public Health students, devised an educational program
for mothers, and the next year there were no deaths from the disease.*
But the very success of these projects began to undermine the
unity that McGavran had tried so hard to create within the school.
Individual departments had always had their own character and concerns,
but the small size of the faculty and McGavran's insistence on the team
concept had mitigated differences among them. By the mid-1950s, how-
ever, a perceptible tension between solidarity and individualism had
begun to emerge. A number of factors contributed to this development.
First, institutional growth naturally made it more difficult to maintain
the cohesion of the earlier times. Second, many of the school's faculty
had studied at Harvard and The Johns Hopkins, where strong depart-
ments were the rule, and they felt that the best contribution they could
make was to build their own departments at Chapel Hill. Finally, the
policies of federal funding agencies encouraged departmental divisions.
The Public Health Service and the National Institutes of Health provided
adequate categorical funding, which differentiated between disciplines,
but very little funding for core public health activities. A grant might
be available for an epidemiological study on cancer, but rarely did the
federal government provide support for a broad-based study of cancer
84
Frances Gust served as Administrative Assistant
to Dean McGavran from 1950 to 1963. Her
various skills as an administrator, diplomat, and
advisor contributed greatly to the successful
development of the school. She took courses to
better understand the school and the faculty and
eventually earned an M.P.H. degree.
85
that would involve the entire public health team. These patterns in
federal spending meant that there was considerable money for scientific
research and training but less for more programmatic endeavors. ''
Despite these centrifugal tendencies, McGavran fought hard to
maintain a sense of camaraderie at the school. He continued his practice
of having the faculty meet in his office on Mondays for lunch, and
during the football season, the men gathered to wager a dime on the
weekend games. "He felt strongly about trying to create this integration,"
Hilton Goulson remembered, "to get people to talk across departmental
lines." "He promoted this sense of togetherness and friendliness and a
kind of informality," Rebecca Bryan recalled, "but he had high expecta-
tions of everyone, and there was no playing when you needed to be
working."^
Biostatistics was one department that grew rapidly during the late
1950s as a result of increased federal funding. America's fascination with
computers created a demand for statistical assistance in the School of
Public Health, the Medical School, and the Public Health Service that
quickly outstripped Bernie Greenberg's ability to supply. During his
first flush of success in the early 1950s, Greenberg complained that "as
additional burdens and responsibilities have mounted geometrically, there
Bernard Greenberg (center) and James Grizzle (right) of the School of Public
Health consulting with George Penick of the Medical School.
86
has been only an arithmetic increase in funds available for personnel."
With hard money from the state in short supply, Greenberg had to
look elsewhere. For most of the decade, training grants from the Public
Health Service and research money from the American Public Health
Association (APHA) paid the salaries of Greenberg's growing staff. The
Public Health Service training grants supported fellows, who did both
research and teaching.'
As with other departments, growth only increased the need for
more space. Biostatistics started out in the annex known as Public
Health Building A on the north side of MacNider Hall. "Inadequate
housing and limitations in physical space are beyond the point where
they are merely inconveniences," Greenberg wrote in 1951. "At the present
time they are health hazards. Every one of the staff suffered an undue
number of colds because of the lack of floor insulation, poor heating
facilities, and drafts." The department obtained additional space in
Annex B the next year, and the APHA project found offices in Miller
Hall. By 1960 Greenberg reported that the department was spread out
all over campus. '°
In September, 1956, Biostatistics undertook its largest research
project to date, a study for the APHA of factors influencing physicians
to enter public health. The grant allowed Greenberg to hire a number
of research associates, including Roy Kuebler, James Grizzle, and Bradley
Wells, all of whom later joined the faculty.
Although research activities increased during the 1950s, teaching
and service remained the mainstay of the school. Devising a curriculum
for public health students required a great deal of discussion and ex-
perimentation. During the Rosenau years, individual faculty members
taught courses in their specialties, while visiting instructors filled in the
gaps. With the addition of new departments and faculty in the 1940s,
McGavran pushed for a core curriculum. All M.P.H. and M.S.P.H. stu-
dents were required to take Epidemiology, Public Health Administration,
Public Health Statistics, Parasitism and Human Diseases, Principles of
Sanitation, and Public Health Nursing. In 1950 the faculty began reeval-
uating that scheme. For two years, school and departmental committees
discussed the appropriate body of knowledge required of public health
practitioners. By 1952 and 1953 a revised curriculum was in place. In-
cluded were PH102, Principles and Practices of Public Health, and PH103,
Applied Principles and Practices of Public Health.
87
Q5"g
H I O
I
c
.._ _.-S-\*-'^
,^..XAl^_
-/
Rosemary Kent and Elta Mae Mast work with high school students in the Schley
community.
For the field-oriented staff, PH103 "represented the peak in cur-
riculum planning." Dean McGavran described the course:
All departments were involved in this project. The total student
body was enrolled in the course — all the faculty were participants
and the total staff of the four field centers within a fifty-mile radius
of Chapel Hill became the "clinical instructors." One day a week
was set aside for this course from 7:00 a.m. to 7:00 p.m. Each faculty
member took four or five students in his (or her) car and went to
"his community patient." . . .These small groups "observed the patient"
superficially — they gathered "patient opinion" on health matters —
they studied the record — interviewed official and voluntary health
and related agencies and individuals, observed schools, factories,
facilities, and activities and functions of health departments and
other agencies, and finally picked one particular. . .area for study in
greater depth.
Although the students and faculty seemed to benefit from this
hands-on learning, it was expensive and time-consuming. Soon many
faculty members lost their enthusiasm and the course was phased out.
"But it was a superb experiment," McGavran remembered, "and for two
brief years the School of Public Health demonstrated to students, prac-
titioners, and ourselves that there was a public health team."^'
89
This team concept was applied more effectively when done volun-
tarily. Maternal and child health's Geraldine Gourley remembered that
"during those times we did a lot of teaching in other departments. I
taught interviewing in public health nursing and education, even in
biostatistics. I taught health problems with special social implications."
This kind of interdisciplinary cooperation extended outside the class-
room. "I spent a lot of time with Roger Howell in the Department of
Mental Health," Gourley recalled. "We went around all over the state
with workshops for social workers, nurses, and various people around
mental health issues."'^
Epidemiology had been one of the original departments in the
school, headed first by Rosenau and then by McGavran. But adminis-
trative responsibilities left little time for teaching or research by either
of the deans. "The result," McGavran wrote in the 1953-54 annual
report, "is that this department, which should be the strongest in the
School of Public Health, is actually the weakest." That situation began
to turn around in 1954 when McGavran obtained funds from the Public
Health Service to start a Chronic Disease Section, for which he hired
Dr. John Cassel. A native of South Africa, Cassel received his medical
John Casse
90
degree at the University of Witwatersrand. He won a Rockefeller Foun-
dation fellowship to study at the School of Public Health in 1952, and
after receiving his M.P.H. he returned to South Africa to work as a
medical officer at a health center.'^
Medical science had made such strides since the late nineteenth
century that by 1950 there were effective cures for most infectious dis-
eases. But scientific understanding of chronic maladies such as cancer,
mental illness, and heart disease was still rather primitive, and investi-
gations of these illnesses dominated the medical research agenda. Cassel's
job was to provide instruction in the treatment of cancer and other
chronic diseases to public health students and to conduct epidemiological
research on such ailments. Cassel quickly established a reputation as an
excellent teacher and researcher and within a few years had received
attractive offers from both The Johns Hopkins and Harvard. '"*
Epidemiology grew dramatically in 1958 with the addition of three
new faculty members paid by training grants from the Public Health
Service and NIH. McGavran wanted an experienced, well-known person
for the job of chairman and, through John Cassel, contacted Dr. Sidney
Kark. Kark was professor of social, preventive, and family medicine at
the University of Natal in South Africa, but prior to his academic
appointment had had extensive experience as a public health officer
and as a research epidemiologist. Kark was at the time pursuing a job
with the World Health Organization (WHO), but McGavran offered
him a one-year contract to help direct the growth and reorganization of
the department. ^^
Kark left after a year to be WHO professor of public health and
social medicine at the Hebrew University in Jerusalem. McGavran
recommended John Cassel as Kark's replacement. A few years later
McGavran wrote to Kark, "I am sure you would be proud to see how
well John Cassel has continued and developed your good work here in
establishing a dynamic Department of Epidemiology. John is a jewel
and is gaining more and more national recognition. His department is
stimulating to students and faculty alike and intensely loyal to John. I
think we have a new and fresh approach to the teaching of epidemiology
which is going to make its mark."^^
That fresh approach involved a focus on the social causes of dis-
ease. Michel Ibrahim, another future dean, came to study at the school
in 1960. He spent one year in biostatistics, but a desire to use his medical
91
J
n c
- — . —
Emil Chanlett with students on the Program and Steering Committee in 1950. Seated, left to right: Chanlett, Barbara Adams,
Mary-Katherine Rellahan, Ruth Richards. Standing: Wayne Messick, Alfred Fletcher, Eugene Taylor, Charles Campbell.
background led him to transfer to epidemiology. Ibrahim described the
insights that propelled Cassel's research and teaching: "Most of medi-
cine was very biologically oriented. We thought in terms of germs and
degenerative diseases. He advanced the theory — he did not invent it,
but he pushed it very hard — that social and psychological factors affect
people's health. [He was concerned with] cultural values, societal values
and stress and how they related to illness."'^
While biostatistics and epidemiology flourished in the 1950s, the
Department of Mental Health hung on for dear life. The initial funding
from the Public Health Service proved inadequate to support Dr. Roger
Howell, the department's only faculty member, on a full-time basis, so
he also served as acting director of the Mental Health Section of the
State Board of Health. Dr. Howell spent many hours in the field, work-
ing with local agencies and talking to civic groups about mental health,
a new and sometimes difficult subject for Americans in the 1950s.
92
Howell resigned in 1957 to accept a position as director of the
Division of Preventive Psychiatry at the Lafayette Clinic in Detroit,
Michigan. His reasons for leaving indicate some of the problems the
school faced in those years:
Probably the greatest reason for my change concerns the promise
of being able to do research. Being a one-man department, with
rather demanding administrative responsibilities as well as teaching
and field activities, seems to make impossible any consideration of
spending time on research, which is much needed in the field of
mental health. The policy of having to obtain outside funds to
support the department, and to make possible personnel additions
so that research is forthcoming, is rather short-sighted for a progressive
university, interested in advancing the body of knowledge which
will bring greater happiness and health to the people of its state. '^
For a year and a half the department had no faculty members. Finally
the school hired Dr. John Filley as assistant professor and head in the
fall of 1958.
State Health Officer
J. Roy Norton with
Dean McGavran in 1951.
Norton served on the
faculty in the late 1930s
and again in the 1960s.
In 1963 he was president
of the American Public
Health Association.
93
Charles M. Cameron, Jr.
Robert E. Coker, Jr.
With Cecil Sheps's resignation in 1952 to become director of pro-
gram planning in the Division of Health Affairs, the Department of
Public Health Administration lost its most dynamic young professor.
John Wright and a series of visiting professors carried on for the next
few years, but most of Wright's time was taken up with his responsibilities
to the school, the university, and the state. In 1955 Dr. Charles M.
Cameron, Jr., joined the faculty. Another of the school's Vanderbilt-
trained physicians, Cameron had served as a health officer in Tennessee,
as a commissioned officer in the Public Health Service, and with the
North Carolina State Board of Health. In 1954 he had received an
M.P.H. from the School of Public Health. Much of his work at the
State Board of Health and at the school dealt with accident prevention.
Dr. Robert E. Coker, Jr., came on board a few years later. The depart-
ment focused mostly on teaching and service, and by the end of the
decade the three professors were on scores of boards and committees.
The Department of Public Health Nursing continued to attract
large numbers of students throughout the 1950s. Ruth Hay and Margaret
Blee remained the mainstays of the department, both as teachers and
consultants. In 1954 the members of that year's class in public health
nursing presented a portrait of Professor Hay to the school. "It is hoped,"
the students wrote, "that the portrait may be an inspiration to all nurses
94
Margaret Dolan
in the field of public health, and will serve as a constant reminder to
us in fulfilling the challenge Miss Hay had instilled in us."^'
In 1950 a new person who would become a national figure in
public health joined the department. Margaret Dolan came from an old
North Carolina family with strong ties to the university. She received a
nursing degree from Georgetown University and served for a number
of years as an epidemiological nurse, first with the Public Health Service
and then with the Greensboro, North Carolina, City Health Depart-
ment. In 1944 she returned to the university and received her B.S.
from the School of Public Health in public health nursing. She also
received an M.A. from Columbia University in 1953. Margaret Dolan
had an immediate impact, both as a teacher and as an ambassador for
the school. By the mid'1950s she served on boards and committees of
state and national nursing and public health associations. In 1959 she
succeeded Ruth Hay as head of the department. ^°
The Department of Public Health Nutrition grew more slowly
during the 1950s. In 1949 Frances MacKinnon, a nutritionist and dieti-
tian with rich experience in public health practice and teaching, joined
the faculty, bringing a clinician's perspective to the department. The
next year the department enrolled its first M.P.H. students. Rebecca
Broach Bryan was a student during the 1951-52 academic year. Like so
95
Frances MacKinnon
Faculty and students in the Department of Public Health
Nutrition, 1958. Rebecca Broach Bryan is third from left in
back row. Hughes Bryan is far right.
96
many other students in that period, she brought valuable experience as
a public health worker to the classroom. "I had a feeling," she remembered,
"that the faculty felt they were learning as much from the students as
we were from them, and they probably were. The department was being
funded by the Children's Bureau, and most students were here on Chil-
dren's Bureau scholarships. When the visiting chiefs from Washington
came, we were a part of the thinking. I felt I had my thinking stretched
a mile."2i
The Department of Public Health Nutrition's strength lay in teach-
ing and service, but Dr. Hughes Bryan continued to do both laboratory
and field research. He began a study with Dr. Greenberg in the early
1950s on the growth of school age children and, with money from the
Public Health Service, expanded the project in 1955 to look more closely
at the relation of diet to growth patterns. Like other members of the
school, Bryan repeatedly complained that the lack of space prevented
him from undertaking any larger research projects.
By the mid-1950s, John Larsh had become something of a senior
citizen in the school, although he was still in his late thirties. His repu-
tation as a teacher and a stickler for academic excellence won him
praise from his students and colleagues. Hilton Goulson came to the
school in 1952 from Luther College in Decorah, Iowa, one of a long
line of students from that college who studied with Larsh. "He was one
of the most amazing teachers that I have ever known," remembered
Goulson. "Completely organized. He would come into a room and be
ready to go, no notes, just a piece of chalk. He would start writing and
talking at the same time, so you'd have to get that knack of listening
and being able to write down what he writes on the board and hope
the lead in your pencil doesn't break. When you got through for the
day, or for the week, or for the semester you had a complete outline of
the subject." "Teaching was my number one love," Larsh recalled. "The
idea that I knew something that I could pass on to someone else was
the greatest thrill I ever had."^^
Although Larsh firmly believed in the primacy of teaching, his
ever-present white lab coat indicated his continuing connection to
research. Larsh's research concerned Trichinella spiralis, the agent of
trichinosis, and some of his students expanded on his early findings.
"The main thrust of our research at that time was trichinella paralysis
in the white mouse," Goulson remembered. Larsh worked closely with
97
these students. "In the early days I'd have one or two working under
me, and I could have time to teach them some techniques. How do
you estimate the number of worms in an animal you have infected?
How do you look at malaria parasites and get the density? I had a policy
that everyone who finished his Ph.D. would publish at least one full-
length paper in which only his name was on it. I felt that was the way
to launch somebody into research. Go through all the facets, show
exactly how it is done. You get the data, but the data is no good if
you don't publish it."^^
The role of research in the school was a matter of contention dur-
ing the whole of McGavran's tenure as dean. John Larsh remembered
his first interview after McGavran arrived in Chapel Hill:
I'll never forget how disappointed I was with him. I thought I would
impress him with how much research I had got done. He says,
"Well, if you want to do it, that's all right, but that's not helping
the school." I thought, my god, if research doesn't help the school,
why do we do research? He didn't clip anybody's wings, it was just
his blunt way of saying, well, I'm not interested in that. I'm inter-
ested in the school making a reputation as being a resource for the
community.
See, Dr. McGavran was a dyed-in-the-wool field man. Rosenau had
no experience out in the field. Rosenau I picture as more of an
intramural type. He wrote his famous textbook, he was a researcher
at the National Hygienic Laboratory, and he taught. But he did
not go out and see how public health really worked out in the
field, but that's what McGavran did.^**
Although Larsh was more committed to teaching and research than to
field work, he supported McGavran's notion that the primary respon-
sibility of a school of public health was to train practitioners. "You are
not trying to train research people," he said, "you are training people
that know the value of research."^^
The Department of Experimental Medicine, however, was one area
in which pure research held sway. In looking back, McGavran acknowl-
edged the department's contributions (not the least of which were the
funds it received from the Public Health Service) but felt he had set a
dangerous precedent. The department, in his opinion, "remained an
'institute of research' housed in the School of Public Health — separate
and distinct in every regard. . . . The only excuse for research in an edu-
98
John Larsh and Hilton Goulson working with students in the Department of Parasitology.
cational institution," McGavran wrote, "is that it becomes part of the
teaching and learning process and not an end in itself; that it enriches
and strengthens education, faculty and students alike. This does not
(and did not) happen when the research is conducted in a separate
institute — call it a department or what have you. This research institute
is the 'European pattern,' which has been followed by too many insti-
tutions in this country."^*
Dan Okun, on the other hand, believed that "teaching and service
is best done when built on a research foundation."
In the early days of the school there was no research going on.
McGavran was for teaching, improving everybody. My feeling has
always been that there are some functions that could be better
served by some of the other schools [in the state]. We shouldn't
occupy space here to do only what McGavran wanted to do, take
someone from this level and raise them to that level. That was an
99
Daniel Okun presents an "honorary degree" from the Department of Sanitary
Engineering to Marie-Therese Francotte for her support of her husband,
Francois, while a student at the school. Attitudes about female roles varied
widely at the school since departments were largely segregated along gender
lines.
academic service obligation, but one that could be met by other
institutions. We had big fights about it and most of the rest of the
faculty in the School of Public Health — when I came here — did not
agree with me.^^
In any case, by the late 1950s, federal funding policies were making
McGavran's priorities increasingly difficult to sustain. Federal research
money became more plentiful, while money for teaching and operating
expenses remained in short supply. The school, however, did receive a
needed shot in the arm in 1958 with the passage of the Hill-Rhodes
Act. The bill allocated a million dollars annually to the nation's eleven
schools of public health based on the number of federally sponsored
students they admitted. Unfortunately, Congress did not appropriate
money until the next year, and even then the funds did not cover the
cost of educating the students. Nevertheless, McGavran called it a "step
in the right direction." "If continued," he said, "it will assist the schools
materially in improving and expanding the amount and caliber of
education in public health."^^
The people of North Carolina also seemed more receptive to the
school's needs. On October 27, 1959, voters approved a bond issue for
100
Faculty and itatt at the ground-breaking ceremonies tor Rosenau Hall, February 6, 1961.
capital improvements for state institutions and agencies, which included
a million dollars for a new building for the school. School of Public
Health alumni and staff played an important role in securing the favor-
able bond vote through their involvement in the North Carolina Public
Health Association. The association sent letters to its 1200 members
asking them to promote the bond in their communities. The associa-
tion's successful promotion of the bond drive was one indication of the
school's growing influence. As more and more graduates took positions
in local health departments, they used their training to spread the
school's philosophy throughout the state. ^'
School officials appreciated the support of the people of North
Carolina, but a million dollars was far short of the needed funds. For-
tunately, Congress directed construction funds under the Grant and
Research Facilities Act to the Public Health Service, which in turn
provided $700,000 in matching funds to the school. ^°
Ground-breaking ceremonies for the new building took place on
January 16, 1961. The dean posed with shovel in hand, and the faculty
and staff huddled around him on a cold and snowy day. On another
cold day that January, President John F. Kennedy, enjoined his fellow
Americans, "Ask not what your country can do for you, but what you
can do for your country." Kennedy's rhetoric of self-sacrifice resonated
101
deeply with those who had already devoted themselves to furthering
the cause of public health, and public health leaders looked forward to
help from the new administration.
Kennedy's domestic policy, as it turned out, offered few new pro-
posals on health care, although it did support additional money for
construction of health facilities and scholarships. The thrust of his
legislative efforts was the Democratic Party's continuing fight for the
addition of hospital insurance to Social Security. In May, 1961, Dean
McGavran testified before the U. S. House of Representatives on a bill
"to expand and improve community services and facilities for the health
care of the aged and chronically ill." McGavran spoke forcefully for the
bill, but he also offered two amendments on behalf of the American
College of Preventive Medicine that would remove the ceilings on grants
for schools of public health. If additional funds for training were not
also made available, he argued, new services would only aggravate the
shortage of trained personnel.^'
The construction of a new building and the inauguration of a
new young president portended a new era at the school. Soon the torch
would be passed to a new generation. Ruth Hay and Margaret Blee
were the first of the "old guard" to retire. In 1960 they started serving
on a half-time basis, and in 1962 took full retirement. That same year
Lucy Morgan turned over the chair in public health education to Ralph
Boatman. Dean McGavran also announced his retirement.
Such transitions provide institutions with an opportunity for re-
flection, and the school cast its eye backward on a number of occasions
in the early 1960s. Dr. Rosemary Kent undertook a history of the school
in 1962. For many months she and other members of her committee
searched the university archives, examined records in the Dean's Office,
and corresponded with old friends of the school. The eventual publica-
tion provided only a sketch of the early years, but the effort generated
great interest in the school's past and preserved many important
documents. ^^
The school also participated in a university-wide self-study in
1962. The report presented the state of the school on the eve of Dean
McGavran's retirement. Growth was the key word. Enrollments were on
the rise. Research funds were increasing. The faculty was not only growing,
but salaries and benefits were beginning to catch up with those of
other schools.
102
Construction of the new
School of Public Health
building.
Belou; Retirement dinner for Ruth Hay
and Margaret Blee at the Carolina Inn
on the Chapel Hill campus. School of
Public Health faculty have probably eaten
more meals per capita at the Carolina
Inn than any group on campus.
103
Brock Chisholm, former director-general of the World Health Organization, discusses international health issues with
Dean McGavran, Frank Graham, and Lucy Morgan.
Any academic institution's reputation is based on the reputation of
its individual faculty members. Research and teaching are the primary
criteria for judging an individual's standing in the profession, but in a
service-oriented field like public health, activities outside the classroom
and the laboratory are also crucial to the individual's and the school's
reputation. From working with local schools and health departments to
consulting with the World Health Organization in various parts of the
world, the school's staff spent thousands of hours dealing with practical
health problems. "This leadership role," the self-study committee reported,
"is more than a prestige factor in the School of Public Health. It pro-
vides for better student recruitment and selection, better learning and
teaching situations, revitalization of research, and closer correlation with
community need and educational effort. Good performance here is to
the School of Public Health what good performance in patient care is
to the Medical School.""
There was a momentum in public health that the 1963 self-study
report very accurately predicted. The committee foresaw growth in the
104
number of students and federal money and in the diversity of educa-
tional programs. "In all these things," the committee wrote, "we shall
either move ahead with the tide or be left behind in the wash; there is
no halfway alternative." The waves of the future, according to the com-
mittee, were health care, environmental health, and international health.
Who or what determined the destiny of public health, the committee
did not say. The issue was not why, but how.^"*
The development of new programs and the addition of more faculty
members entailed some administrative changes that ran counter to
McGavran's "town meeting" vision. In 1952 an Executive Faculty Com-
mittee, made up mostly of department heads, replaced the general faculty
as the policy-making body of the school. Then in 1959 McGavran
appointed his first assistant dean, Dr. Millard Bethel. Dean McGavran,
in a confidential comment included in his "Report to the Faculty," warned
his colleagues about the consequences of continued growth.
None of the faculty will probably wish to change the democratic
administrative approach to the organization and operation of the
School of Public Health, but the change may come anyway. Increas-
ingly in the past year, the executive faculty had insisted upon the
Dean's Office assuming more and more of the functions which in
past years have been carried on by faculty individuals and through
committees. These have been called administrative details; for example,
the preparation of the catalogs, much of the administrative activity,
and scheduling of classes.
Admittedly, these activities are time consuming functions that remove
faculty "from departmental activity, from important teaching, re-
search, and services," but I warn you that you can't "have your cake
and eat it." The incoming dean (as I would) will no doubt bow to
these faculty pressures and even welcome more administrative con-
trol unhampered by the democratic process, but what will be the
net result? Be sure you want to lose control before you dump "chores."
There are few schools with faculties that have the responsibilities
and opportunities to guide their school that you have earned. Re-
sponsibilities with subsequent opportunities are easier to keep than
to get. ^5
To the end McGavran tried to forge the unity he felt was necessary
for a successful public health team. "One of the last things he did,"
Hilton Goulson recalled, "and one that I remember so vividly, was to
walk through the entire building making certain that there were no
105
William Friday, Abel Wolman, Dean McGavran, Henry Clark, and Hugh Holman.
coffee pots. Coffee pots were not allowed because he had a coffee room
down on the first floor, and everybody was supposed to come down
there and drink coffee." Soon after McGavran left, however, the room
became a laboratory. ^^
By the spring of 1963, the School of Public Health had much to
be proud of. The student-faculty ratio had declined dramatically, state
appropriations had increased steadily, and research funds supported
many important projects. The dedication of the new School of Public
Health Building (the building was not officially named for Dr. Rosenau
until 1965) brought hundreds of people to Chapel Hill for two days
of speeches, discussion, and socializing. Some of public health's most
notable personages graced the stage of the new auditorium. On Saturday
morning, April 6, 1963, Dr. Abel Wolman, professor emeritus of sani-
tary engineering at The Johns Hopkins, presented the opening address.
That afternoon four group sessions discussed the past, present, and
future of public health. A speech by the school's most senior supporter,
Frank Porter Graham, highlighted the evening activities. On Sunday
morning John Wright planted a southern magnolia in memory of Milton
J. Rosenau, and that afternoon North Carolina Governor Terry Sanford
dedicated the building. The future seemed so promising that nostalgia
for the past was fleeting. Dr. and Mrs. McGavran were headed to India;
the school had a new home and soon would have a new dean.^''
106
William Friday, president of the University of
North Carolina, and Ida Friday, a former student
and instructor in the Department of Public Health
Education, both long-time supporters of the
school, greet Leila Morgan at a reception during
the dedication.
Frank Porter Graham
and Miss Ruby Ross, Dr.
Rosenau's secretary, ex-
change greetings at the
dedication ceremonies.
107
108
r^hapter
CONFLICT AND
CHANGE
The 1960s was among the most tumultuous decades in American
history. The civil rights movement, student protests against the
: __ war in Vietnam, and women's demands for equality helped
define the times. The assassination of President John F. Kennedy rocked
the nation in 1963, and within five years assassins' bullets had killed
Malcolm X, Martin Luther King, Jr., and Robert Kennedy. Violence
broke out in urban ghettos, in small southern towns, and on college
campuses, as the struggle for justice and equality tested the mettle of
the nation. In an effort to confront some of the republic's more obvious
problems, Congress passed civil rights laws and channeled millions of
dollars into social programs. This search for the good society ended
with the expansion of the war in Vietnam and Richard Nixon's election
in 1968.
The decade represented something of a golden age for the public
health movement. Medicare and Medicaid were the centerpieces of Pres-
ident Lyndon Johnson's "Great Society" programs. But smaller measures
also left their mark. Particular programs sought to increase medical
research, reduce barriers to health care for the poor, develop treatments
for chronic diseases, and reduce the gap between scientific knowledge
and available health care. During Johnson's administration. Congress
passed over forty pieces of health care legislation, and millions of dollars
became available for research and training.'
At the School of Public Health, the search for a new dean began
shortly after Dr. McGavran announced his retirement in 1962. A search
committee chaired by John Wright considered dozens of candidates.
Many were unavailable at the time, and philosophical differences among
committee members eliminated others from consideration. In the end
109
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EV-an W illiam Fred Mayes
the committee nominated Dr. William Fred Mayes, a choice strongly
supported by McGavran.^
Fred Mayes had a varied background as a public health teacher
and practitioner. He received both his B.S. and M.D. from the Univer-
sity of Kansas, where he also did his residency in pediatrics. Mayes
worked as a local and state health officer in Kansas before taking an
M.P.H. at Harvard in 1948. After that he served as health director for
the town of Brookline, Massachusetts, and as a professor at the Harvard
School of Public Health. A two-year stint as a U.S. health adviser in
Pakistan preceded his move to Washington to join the Public Health
Service. When he accepted the job at Chapel Hill, he was directing the
agency's Division of Research Grants in the Bureau of State Services.^
The new dean barely had time to unpack before a series of national
and international events intruded on the quiet village of Chapel Hill.
John Kennedy's assassination, civil rights protests along Franklin Street,
and the speaker ban controversy (an attempted legislative mandate to
require advance approval of all campus speakers) shook the university
community. More profoundly transformative, however, were the explosions
of knowledge and population that characterized the period, and both
had major implications for public health. On the one hand, investments
in education begun in the 1950s paid off in the 1960s with major ad-
vances in the biological, physical, and social sciences. On the other, the
baby boom of the 1940s sent student enrollments skyrocketing while
110
the rising birthrates in underdeveloped countries presented public
health professionals with new challenges.
The School of Public Health grew tremendously, and both the
administration and the faculty deserved much of the credit for its success.
But dollars from Washington and Bethesda (the home of the National
Institutes of Health) fired the engines of growth. In 1962 the school
had a budget of almost $2 million, with just over $1 million coming
from the Public Health Service. By 1972 the service contributed $3.5
million out of an $8.3 million budget.''
The Department of Environmental Sciences and Engineering set
the pace in the 1960s. The economic boom of the post-World War II
years provided Americans with the highest standard of living in the
world, but the affluent society generated many potential dangers to the
environment and to the public's health. Chemicals, radioactive wastes,
and contaminated water were just a few of the by-products of
development.
In the late 1950s, Dan Okun acquired funding from the Public
Health Service and enlarged the department's mission to include the
study of these new environmental dangers. Lyman Ripperton in air
hygiene, David Eraser in industrial hygiene, and Donald Johnson in
sanitary chemistry came aboard, bringing their expertise in these new
fields. In 1962 the department changed its name from Sanitary Engi-
neering to Environmental Sciences and Engineering and organized its
courses into five program areas to allow students the opportunity for
specialization: sanitary engineering and water resources, environmental
chemistry and biology, environmental and food sanitation, air and in-
dustrial hygiene, and radiological hygiene. ^
Okun and his colleagues recognized that environmental issues in-
creasingly demanded interdisciplinary research and teaching. In the early
1960s, they set up two joint training programs with North Carolina
State University. The Public Health Service saw merit in this approach
and provided funds to create an Institute for Environmental Health
Studies (now the Institute for Environmental Studies), with Okun serving
as director. The institute brought together faculty from the Departments
of Biostatistics, Botany, Chemistry, City and Regional Planning, Envi-
ronmental Sciences and Engineering, Epidemiology, Geology, and Zoology
at Chapel Hill, along with the Department of Food Science at North
Carolina State. Dr. Stanley Weidenkopf, the deputy director, oversaw
111
David Fraser instructs a student in
the use of an electron microscope.
Otto White, Jr., and Harvey Jeffries prepare experiments
for their joint technical paper in the M.S.P.H. program.
*s:
'f^-
^
v*SS«'"
^^^^^
C
Charles Weiss (center) at work in the lab with graduate students Frank Wilkes (left) and Alan Rubin (right).
112
the day-to-day operations of the institute, which prepared pre- and
postdoctoral students for careers in environmental health.'^
The Department of Environmental Sciences and Engineering estab-
lished a quarterly newsletter, ESE Notes, to communicate the results of
its expanding research program. ESE Notes featured short, technical
articles about ongoing projects, as well as reports on student and faculty
activities. Early titles included "Ozone in the Atmosphere Over the
Southern Appalachians," "Biological Monitoring of Exposure to how
Level Air Pollution," and "Phosphate Concentrations and Marine Algal
Ecology."^
The department's expansion can be attributed to a number of
factors. It had an illustrious history, going back to the early 1920s
under the nationally known engineer Thorndike Saville, and continuing
in the 1930s and 1940s as H. G. Baity established a worldwide reputa-
tion as a teacher and a sanitary engineer. Dan Okun built on this
foundation by widening the scope of the department's research and
teaching, hiring excellent faculty, and recruiting good students. The
department was in a perfect position to ride the wave of concern for
environmental issues that appeared in the 1960s.
The Department of Biostatistics also grew rapidly in the 1960s.
Here too, the presence of an ambitious, nationally known chair and an
expanding federal budget contributed to the department's success. Bernard
G. Greenberg began building the Biostatistics Department in the late
1950s with government and foundation money, most of which went to
research. Although Greenberg and his colleagues did a great deal of
teaching in the School of Public Health, as well as in the Schools of
Medicine, Nursing, and Dentistry, the department had few students of
its own. Still, Greenberg and his colleagues found many ways to serve.
"Statistical advice on design of experiments and interpretations of data,"
an anonymous faculty member wrote, "is dispensed with a lavish hand
to those who seek it." Slowly, the department's reputation and the avail-
ability of fellowship money attracted more and better students. By 1967
the department had a strong doctoral program that included specializa-
tions in biometry, demography, genetics, and computer sciences.^
For a time the new space in Rosenau Hall adequately served the
needs of the Biostatistics Department. There were individual study
spaces equipped with electric desk calculating machines for each student.
113
Ruth Stephenson Hassanein and Ellen Kaplan, research associates in biostatistics, examine data from
the Univac computer in the early 1960s. Biostatistics was one of the first departments on campus to
use computer technology.
Jabbar Sherwani of the Department of Environmental Sciences and Engineering displays an analog computer
used for ground-water studies in eastern North Carolina.
114
There were laboratory rooms with IBM punch card machines and a
Friden Flexowriter for punching paper tape to be used in the university's
Univac computer. But another growth spurt in 1965 quickly filled the
available rooms in Rosenau. Once again the department found it neces-
sary to move faculty and staff into temporary space, in this case the
Drane Cottage and Drane House behind the school on Pittsboro Street.'
Perhaps the department's most enduring contribution during this
period lay in establishing the Carolina Population Center. The school
began discussing the possibility of creating a center for population studies
in 1964. The idea was to coordinate ongoing research and teaching on
population issues, to expand consulting services to state and local health
agencies as well as to foreign countries, and to increase theoretical re-
search on population at the university. The Carolina Population Center
was set up in 1966, with Moye Freymann as director. The scope and
urgency of population problems in developing countries, along with
financial support from the Ford Foundation, resulted in an early con-
centration on international issues. In North Carolina, the center worked
with local agencies to develop a comprehensive family planning
program. '°
Forrest E. Linder, professor
of biostatistics and founder
of the Poplab, an agency
that helped other countries
develop better demographic
statistics for population
study and planning.
115
Bert Kaplan
Some members of the Department of Epidemiology faculty during the early 1960s.
116
The other bright star in Dean Mayes's "constellation" was the De-
partment of Epidemiology. The department undertook numerous studies
in the 1960s, but the Evans County Cardiovascular and Cerebrovas-
cular Epidemiologic Study drew the most attention. Evans was a small
Georgia county about sixty miles inland from Savannah. Dr. Curtis
Hames, a local physician in Claxton, noticed in the 1950s that the black
patients he treated seemed to have a lower incidence of coronary heart
disease than whites. He contacted the Public Health Service about the
possibility of doing a study in Evans County to see if his clinical obser-
vations were correct, and if so what the explanation might be. The
Public Health Service suggested that Hames contact the Department of
Biostatistics at Chapel Hill for help in designing the program. Bernie
Greenberg remembered the occasion:
The Public Health Service asked me to evaluate a research project
proposed by a solo medical practitioner in private practice in Clax-
ton, Georgia. I visited there for a few days with this physician but
returned with serious doubts about the project's feasibility.
Nevertheless, I persuaded John Cassel to go back to Georgia with
me a few weeks later to meet Dr. Curtis Hames in order to take a
closer look at this project. I was still skeptical when we got on the
plane to go there, but by the time we came home, John and I were
thoroughly convinced that this project represented a unique epi-
demiological potential.''
Between 1960 and 1962, 92% of Evans County's population over
the age of forty underwent medical examinations and laboratory tests.
The results confirmed Hames's observation. Black males suffered heart
disease at half the rate of white men. More surprising, however, was
the fact that white men in lower socioeconomic groups had rates com-
parable to blacks. When the investigators studied the population again
between 1967 and 1969, there was less difference among white men.
"The only circumstances in which white men had as low rates as blacks,"
John Cassel reported, "was when they were both sharecroppers. The
only relevant difference between white sharecroppers and all other white
men that could be invoked to explain this finding was the high level of
physical activity in sharecropping." Hames and the school's epidemiol-
ogists concluded that psychosocial experiences and genetics might be
contributing factors, but that levels of physical activity were primarily
responsible:'^
117
Curtis Hames (standing) and Herman Tyroler with delegation from
the People's Republic of China.
That study grew exactly as John [Cassel] had predicted. Today it is
the most famous nongovernmentally-administered cardiovascular
study in the world. Dr. Curtis Hames turned out to have the medical
and managerial capability that John had seen in him, and the
Evans County project became a uniquely comprehensive field of
study of heart disease in a natural, rural setting.
The project had given rise to hundreds of manuscripts, dozens of
doctoral dissertations, and best of all, to some of the most important
discoveries ever made about the precursors of coronary thrombosis,
hypertension, and myocardial infarction.'^
The rapid expansion of the Departments of Environmental Sci-
ences and Engineering, Biostatistics, and Epidemiology caused concern
among some members of the faculty. The increasing emphasis on research
was one issue, but, in addition, not everyone supported the strategy of
building the school on soft money supplied by the federal government.
"I didn't believe in being paid to do research," John Larsh, head of the
Department of Parasitology, said. "It rubbed me the wrong way. A lot
of my good friends, Bernie Greenberg, Dan Okun, and a lot of them,
they took every damn grant that came along. Soft money, that's the
way you expand. My point was that larger was not necessarily better."
Hilton Goulson explained:
John Larsh's philosophy was let's develop a department on solid
ground and to him solid ground meant state appropriations. He
would build the department by developing faculty positions with
state moneys. He was not as enthusiastic about federal dollars. The
department would literally get calls from NIH, "We've got this grant
118
program, wouldn't you like to apply?" Money was available for the
asking. His philosophy was we are primarily here as teachers, but
we will do research as we can budget out time.'''
Everyone on the faculty understood that long-term security de-
pended on appropriations from Raleigh, but some, like Dan Okun, saw
the pursuit of federal grants as the most effective short-run strategy.
"We didn't grow out of state money," Okun explained, "we grew on soft
money. The state money followed the soft money. We would get a project
and hire someone on soft money. We'd have a guy and we'd say, 'Look,
you're coming here but your staying depends on your being productive.'
So we'd try to find someone who would be productive, get research
grants. The next time there was state money, we said, 'Look, we've got
this guy already here.' It was a tactic which was useful at the time."'^
Daniel Okun with 1965 purchase award, "September Party" by George Kachergis, at the School of Public Health
Annual Art Exhibition. Dr. Okun got the idea for displaying and purchasing work by local artists while in the
Netherlands, where art is used extensively in public buildings.
119
Not everyone appreciated Okun's ability to bring money into the
school. "There was a lot of tension," Okun remembered. "We were thorns
in everybody's side. The problem in our department was always space.
We needed laboratory space, not space for offices. There was a labora-
tory above us in [the Department of] Nutrition. They weren't doing
any research work at the time, so we made a deal to use their labora-
tory space. I went up and asked if we could [also] use their desks. [The
department head] said 'You're a cancer in the school.' This is the way
we were perceived because we were growing. We had needs for everything
[because] we were getting research grants. So there was a lot of tension.
I won some battles but felt I may have lost the war."'^
During McGavran's time Okun may have suffered some setbacks,
but by the mid-1960s the research-oriented departments exercised con-
siderable influence in the school. Although Dean Mayes had initially
been seen as a strong defender of an older community-service orientation,
under his leadership the school's focus clearly shifted to research. William
Herzog, a student and faculty member at the school, witnessed the
change. "Mayes came in at a time when three of the four horsemen
who were most influential in the school, Dan Okun, Bernie Greenberg,
and John Cassel [Margaret Dolan being the fourth], were very strong
research people. To be credible as dean, Mayes became more supportive
of the research-oriented departments. That was quite a disenchantment
[for some people], in some sense a betrayal. We went from the idea of
the community as the focus of the school to research as the focus." '^
The issue, however, was not merely research versus teaching and
service, but what kind of research and for whose benefit? Any research
effort that relied on funding from government agencies and private
foundations ran the risk of tailoring its agenda to fit the fashions of
the day. Earlier public health activities in underdeveloped countries, for
instance, mixed humanitarianism with political and economic motiva-
tions. During the 1960s, the federal government's interest in finding
cures for chronic diseases often precluded funding vital research on
prevention. '^
The rapid influx of money, faculty, staff, and students required
changes in the school's administrative structure. Dean Mayes, in his
first address to the faculty in 1963, outlined his administrative principles.
These included "an appropriate division of labor among administrative,
professional, technical, clerical, and other fellow workers," the delegation
120
of authority to people in responsible positions, and autonomy for
department heads."
The most noticeable administrative reform involved the expansion
of the Dean's Office. Soon after his arrival, Mayes appointed John Larsh
as assistant dean for academic programs, a position, as Mayes acknowl-
edged, that Larsh had informally held for a number of years. William
S. Flash joined the school as assistant dean for administration and
associate professor of public health administration; John Gentry became
assistant dean for program development; and Harry Spense assumed a
position as a consultant on international health programs. In 1967
Charles Harper took Flash's job as assistant dean, and Robert Moorhead
became an assistant to the dean.
Charles Harper with Hector Zuluaga
121
Unlike Ed McGavran, Fred Mayes saw himself as more than the
executive secretary of the faculty. "The leadership responsibilities of the
dean require going far beyond [that] role," he said. The dean served as
the school's spokesman to the university and the outside world and
held responsibility for safeguarding the long-term interests of the school
and its faculty. Mayes took Harry Truman's motto as his administrative
principle: "The buck stops here." Consistent with the dean's more exalted
role was the decision to rename the Executive Faculty (the heads of all
the departments) the Dean's Cabinet (which included some adminis-
trators, and later, some students as nonvoting members). ^°
Expansion of the administrative structure of the school was un-
avoidable, given the number of people involved. Gone were the days
when the faculty could sit around a table in the dean's office and make
decisions. A stronger central administration was also necessary to balance
the growing inequalities among the different departments. But adminis-
tration was also Dean Mayes's strong suit, and that is where he decided
to put his efforts. ■^^
Lucy Morgan, for one, was uncomfortable with this new adminis-
trative style. In retrospect, she felt that the school was being "ruled by
fiat." The participatory democracy she saw as essential to public health,
whether at the school or in the community was giving way to bureau-
cracy. The consensus style of decision making that had been a distin-
guishing feature of the school was being replaced by more hierarchical
forms. But underlying Morgan's concerns were other serious problems
in the relationship between the Dean's Office and the Department of
Public Health Education, in fact, between the Dean's Office and all the
nonresearch-oriented departments. ^^
The retirement of Lucy Morgan and Eunice Tyler in 1966 left the
Department of Public Health Education understaffed and somewhat
uncertain of its future. When Department Chair Ralph Boatman and
Dean Mayes asked Elta Mae Mast to rejoin the faculty, Chancellor
Carlyle Sitterson questioned the appointment. His primary concern was
"the problem of academic inbreeding. A department the size of health
education which has on its staff no person with graduate training out-
side its own program presents real problems." Mayes admitted that the
department needed to hire someone from outside, but since the school
trained roughly 50 percent of the people in the field of public health
education, it was not easy to do so. In any case, Mayes defended Mast
122
Members of the Department of Public Health Education family gather for the retirement dinner for Lucy Morgan and
Eunice Tyler.
as an excellent choice. "Her value as a very able teacher has previously
been demonstrated."^^
Meanwhile, Mayes had instituted a wide-ranging assessment of the
school, beginning with the Department of Public Health Education.
The dean appointed an external committee to make recommendations
to him and an internal committee to assist in the gathering of materials
and to make suggestions on implementing the external committee's
recommendations. The external committee's most important recommen-
dations addressed the need for more research by both students and
faculty and the hiring of new faculty who had no previous ties to the
department.'^'*
Ralph Boatman stepped down as head of public health education
in 1968 to direct the school's continuing education program. Dean Mayes
appointed a search committee, and the committee selected Dr. Guy W.
Steuart, a native South African then teaching at the School of Public
Health at the University of California at Los Angeles. Mayes approved
the appointment over the objections of the public health education
faculty. Given Steuart's mandate to implement many of the recommen-
dations of the review committee, particularly to upgrade the research
capabilities of the department, the situation was ripe for misunder-
standing and disagreement. In 1971 doctors Betty Mathews, Hiawatha
Walker, Elizabeth McMahan, and Elta Mae Mast resigned. ^^
123
Staying afloat in the 1960s required constant adaptation to new
trends in research and education. The Department of Public Health
Administration, for instance, had to adjust very quickly to the enormous
changes in the health care delivery system that took place in the 1960s.
Robert Coker headed the department from 1960 until his death in
1966. With a small permanent faculty supplemented by part-time visit-
ing instructors, the department taught students throughout the Division
of Health Affairs. The complexities of modern health care management,
however, posed problems. Bill Herzog, who became a member of the
department in 1964, remembered, "The Department of Health Admin-
istration at the time didn't have much depth. Most of the principal
faculty were physicians. It wasn't until the late sixties that they began
pulling in faculty who were trained in public administration, sociology,
health care finance, health care administration."^*
The impetus for change came from the heightened demand for
trained health administrators created by the medical care legislation of
the mid-1960s. Preparations for that change started shortly before Coker 's
death in 1966, when the department undertook a review of its overall
program. The review was put on hold, but the department did revamp
its curriculum and develop new programs, thanks to grants from the
Public Health Service. Arnold Kaluzny, Sagar Jain, Moye Freymann,
and John Gentry were among the new faculty who joined the department
in 1966. In 1967 Morris Schaefer was appointed head of the depart-
ment. The next year the department changed its name to Health
Administration. ^^
The Department of Parasitology also revamped part of its program
to accommodate the demands for health professionals. In the late 1950s,
representatives from the Centers for Disease Control (CDC) and the
laboratory section of the American Public Health Association contacted
the school about providing a training center for laboratory directors.
"A large number of lab directors in state health departments were ap-
proaching retirement age, and there were no training sites," Hilton Goulson
remembered. John Larsh and Ed McGavran expressed interest in the
project but worried about how the students would fit into the existing
degree program. The school and the CDC decided the appropriate
degree would be the doctorate of public health. Although a Dr.P.H.
had been in existence for many years, it was generally a degree earned
in a year by M.D.'s. "That's not what we were interested in," Goulson
remembered. "This program for laboratory directors was similar in most
124
respects to the Ph.D., but rather than emphasizing basic research this
was to emphasize applied research, things that could be carried back to
the laboratories and implemented immediately. It was funded by the
National Institutes of Health with the agreement that students would
come to do their academic training here and their scientific research
would be done at the CDC in Atlanta. We have provided a lot of
much-needed manpower in the public health laboratory, not only the
people who have obtained the training, but others who worked side by
side with them." The program was so successful that in 1969 the depart-
ment changed its name to Parasitology and Laboratory Practice.^®
Relations between the School of Public Health and other schools
in the Division of Health Affairs were either cooperative or competi-
tive, depending on the people and the issues involved. The Department
of Public Health Nursing and the School of Nursing sometimes worked
together and at other times agreed to disagree. Soon after the creation
of the School of Nursing in 1950, there was pressure to eliminate the
baccalaureate degree in public health nursing. This pressure came from
the dean of the School of Nursing, from the National League for Nurses,
and from some people within the School of Public Health. Some of
the conflict was no doubt territorial, but the major issue was whether
or not specialized training (public health nursing as opposed to a more
general course in nursing) was appropriate at the undergraduate level.
Certain to lose accreditation for their program, the department finally
stopped accepting undergraduates in 1962. Despite the uneasy relation-
ship between the Department of Public Health Nursing and the School
of Nursing, the two groups did successfully develop a program to prepare
teachers of public health nursing, beginning in 1963. Margaret Shetland
was the first director, followed by Marie Mclntyre in 1967.^'
Since the undergraduate and certificate programs had been the
Department of Public Health Nursing's mainstays since the early days,
their loss posed a threat to the department's survival. Nevertheless, the
department was able to hang on and grow during the 1960s, thanks in
part to the influence of Margaret Dolan. Dolan brought great distinction
to the department and the school as president of the American Nurses
Association (1963-65) and the National Health Council (1968-69). She
also served as an advocate for improved health services on numerous
state and local boards. Elizabeth Holley and Virginia Nelson had joined
the department to fill positions opened by the retirement of Ruth Hay
and Margaret Blee, and together with Margaret Dolan they formed the
125
William Herzog
Harry Phillips
Leonard Rosenfeld
nucleus of the department. Grants from the Public Health Service and
increases in state appropriations allowed the department to hire addi-
tional faculty.^"
The department m.ade two particularly important appointments in
the late 1960s. In 1967 Elizabeth (Betty) Edmands came to the school
with a joint appointment in public health nursing and maternal and
child health and as a staff member of the Carolina Population Center.
Margaret Dolan considered Edmands "the most knowledgeable public
health nurse in the United States on family planning." Edmands used
her expertise not only in training students but also as a consultant to
numerous governments in Africa and Asia. Marion Highriter joined
the department the next year to improve the research dimension of the
program. Over the years Dr. Highriter supervised numerous research
projects, many of which investigated the effectiveness of public health
nurses in a variety of settings.^'
The school's involvement with international health issues increased
dramatically in the 1960s. The school had had a strong international
orientation since the 1940s. A steady flow of students from Latin America,
India, and the Middle East added a cosmopolitan flavor to MacNider
and Rosenau Halls. Faculty passports bore stamps from all parts of the
world. H. G. Baity's move to Geneva, Switzerland, to work for WHO;
Lucy Morgan's travels to India, Burma, Ceylon, and Egypt the year she
stepped down as head of the Department of Public Health Education;
Ed McGavran's five-year stint in India for the Ford Foundation after he
retired as Dean — all were indications of the faculty's deep involvement
in the world scene.
126
Moye Freymann
Janice Westaby
Dan Beauchamp
Morris Schaefer
William Flash
Lydia HoUey
Some of the faculty who joined the Department of Public Health Administration in the
late 1960s and early 1970s.
127
Norman Weatherly and Hilton Goulson observe students in parasitology
lab. Above, left to right: James Hendricks, Elmer Chaffee, and Robert Watson.
128
Nora Clinc
Some members of the Department of Public Health Nursing during the l'560s and 1970s.
129
Dean Mayes, John Wright, Harry Spense, and John Cassel meet with a delegation of
health administrators from India in 1964.
International efforts consisted of teaching, research, and service,
the threefold mission of the school. The Department of Environmental
Sciences and Engineering, for instance, established a nondegree training
program for graduate sanitary engineers from developing countries in
1962, with grants from the Agency for International Development. The
program eventually drew students from all over the world. The school
also trained health workers for duty in foreign countries. In the summer
of 1965, the public health faculty cooperated with the medical schools
at UNC and Duke in a training program for Peace Corps doctors. ^^
A more ambitious training and service project was "The Malawi
Public Health Program," a Peace Corps project supervised by the Depart-
ment of Epidemiology. The program took Peace Corps volunteers with
no professional health training, brought them to Chapel Hill for four
months of instruction and then sent them to Malawi in south central
Africa to work on the prevention and cure of tuberculosis. The program's
objectives were twofold: implementation of an integrated health program
using nonprofessionally trained personnel and the training of national
counterparts so that health activities could continue following the Peace
130
The International Program in Sanitary Engineering and Design, supported by the United States Agency for International
Development, brought engineers to Chapel Hill for advanced study. Seated, left to right: James Brown (UNC), Jeff Flanagan
(American technician from Burma), Vincent Hemming (Jamaica), Pedro Parada (Bolivia), Salman El-Rawi (Iraq), Emmanuel
Ojo (Nigeria). Standing, left to right: George Barnes (UNC), Daniel Okun (UNC), Horace Beckford (Jamaica), All Shubber
(Iraq), Walter Fabian (Costa Rica).
Corps's withdrawal. John Cassel beamed with pride as he inspected the
troops. "I have just completed a tour of Malawi with Bill Peck looking
at our Peace Corps project. I must say that even though I realize that
it's still in its early stages, I was absolutely delighted with the way it
had progressed. ... I am really proud of the training they got in Chapel
Hill ... as they are probably the best-prepared bunch that have ever
been sent out to Malawi."^^
In the late 1950s and early 1960s, a pattern of social life oriented
toward departments rather than the entire school had developed. The
rapid growth of the school while Fred Mayes was dean reinforced this
pattern. The Departments of Public Health Nursing and Public Health
Education, with their large classes made up mostly of women, set the
pace. Ruth Hay and Margaret Blee served Hogan stew to students at
their home, Dun Roaming; while Lucy Morgan and Eunice (Pickie) Tyler's
home, Lichenwood, served as the scene of numerous social events. As
more faculty joined the Department of Environmental Sciences and
Engineering and the student body increased in size, Dan Okun inaugu-
rated annual parties for faculty and spouses, informal gatherings for
students and faculty, and an annual banquet.
The Department of Maternal and Child Health exemplified this
spirit of intradepartmental camaraderie and cooperation. Maternal and
131
child health programs received special attention from the Johnson ad-
ministration, particularly efforts to reduce infant mortality rates. The
department benefited greatly from the increases in federal funds. Ann
Peters, Naomi Morris, Jaroslav Hulka, Richard Udry, Earl Siegel, and
Karl Bauman all joined the faculty in the mid-1960s. "One of the things
that I look back on with great pleasure," Geraldine Gourley remembered,
"was that the department was really close knit, it was like a family. The
Chipmans, the Baumans, the Udrys, the Siegels, the Morrises, and I
were really a very close-knit group, and the students felt that. The stu-
dents were made to feel by everybody on the faculty that they were
professional people to be respected and treated as coworkers in the
health field. It was a wonderful time during those years."^"*
There were attempts to combat this increasing focus on department-
centered activities, to try to maintain an "esprit de corps" that embraced
the whole school. Dean Mayes and his wife Dorothy ('Mrs. Dean')
played an important role in this effort. Mayes explained:
In an effort to become personally acquainted with more students,
Dorothy Mayes prepared food and hosted several groups of students
each year for dinners and receptions in our home. Starting with a
fall reception for international students, the entertaining proceeded
at intervals through the year with home-prepared and served dinners
for the officers, committee chairmen, and spouses of the student
government; for officers and spouses of the Student Wives Club;
for new faculty members and their spouses, and for other special
groups. The year would end up with a final all-day Sunday open
house for all students and their families during commencement
week, opening with a 7:30 breakfast, going to a 10:00 coffee. . ., a
12:30 luncheon aimed at students who were leaving and in the
throes of packing up, a 4:00 tea, and ending with a 6:30 Sunday
night supper— thus breaking up the guest list into previously arranged
manageable groups. ^^
Faculty, staff, and students at the school could not be unaffected
by the upheavals of the 1960s. In many small ways, school programs
and faculty had been catalysts for social change. The school, for instance,
had confronted racial inequality through its cooperation with North
Carolina College. The presence of foreign students, many of whom
were dark skinned, challenged the racial myopia of the region. The civil
rights sit-ins, which started in nearby Greensboro, spread to Chapel
Hill in 1963, and members of the faculty were among the most vociferous
132
Earl Schaefer
Earl Siege
Sidney Chipman
Richard Udry
Barbara Stocking
Geraldine Gourley
Karl Bauman Xaomi Morris Ann Peters
Some members of the Department of Maternal and Child Health during the 1960s.
133
Dean Mayes and Dorothy Mayes congratulate School of Public Health graduate
Robert Verhalen.
supporters of efforts to end segregation in Chapel Hill. Many of the
same people lent a hand when food service workers at the university
tried to organize a union in 1968 and 1969.^^
Geraldine Gourley served on the school's speakers committee, and
she remembered bringing in "some black activists to speak on the civil
rights issue." "I always felt complete support if I wanted to take part in
a demonstration. A lot of people on the faculty did that. I remember
the strike of the cafeteria workers, and in those meetings it seemed like
half of the faculty of the School of Public Health would be represented."
Many faculty members signed a resolution supporting the recommenda-
tions of the Faculty Council for increased educational opportunities for
minority students at UNC.^''
Like most Americans, people at the school had been relatively
apolitical during the 1950s. The protest movements of the sixties, how-
ever, widened the playing field and allowed a more direct challenge to
the status quo. In the late 1960s the School of Public Health attracted
advocacy-oriented students who saw adequate access to health care as a
centerpiece of social change. Many of these students found a home in
the Department of Public Health Education. A group of activists also
centered around the Department of Environmental Sciences and Engi-
neering. Here, they had professors who were outspoken critics of many
environmental policies. In the classroom and in the field, students ab-
sorbed a passion for change, as well as a scientific understanding of the
issues.
38
134
Students supporting the strike by food service workers at the university in 1969. Many faculty and students at
the School of Public Health participated in the movements for social change in the 1960s.
Student activists were not content merely to challenge the larger
political and economic structure, they also questioned some administra-
tive and educational procedures in the school. Student organization
dated back to 1947, when that year's class formed a Program and Steering
Committee. The committee's primary purpose was to organize social
activities that brought students and faculty together. An annual dinner-
dance at the Chapel Hill Country Club and a picnic at Hogan's Lake
highlighted the calendar. This committee functioned for many years,
with Emil Chanlett as adviser.^'
In 1968 students organized a student council, and in 1969 the
Dean's Cabinet invited two students to attend the meetings as non-
voting members. A convocation address by the student council president
in the Fall of 1970 was indicative of the new attitude.
I welcome each of you . . . not in separate categories of 'students' and
'faculty', but as colleagues — co-participants in a mutual education
135
process where all parties have an opportunity to define where they
stand, to share whatever knowledges and experiences they may
have, and to express openly what they expect from one another.
Last year at convocation I alerted those present that emphasis
would be placed upon the use of the student council as an action-
oriented advocate of student educational interests with the desired
outcome that of an improved and more creative learning environ-
ment. That was, and still is, based upon the following premises, the
first of which I've already stated: (1) that students and faculty are
co-participants in a mutual educational process; (2) that students
enter this school, not as completely empty vessels into which a
whole new set of concepts, attitudes, and values will be funneled
by faculty, but with a rich variety of past experiences which can be
tapped and built upon into a variety of new contexts and associa-
tions; and (3) that because students, as well as faculty, do have
these sets of experience resources and special abilities, they have not
only a right but a responsibility to be co-participants in the decisional
processes which help determine the quality of their educational
environment. ■*"
Students were particularly critical of the core course, The Ecology
of Health. There were too many lectures, a group of students wrote to
Dean Mayes, and too much focus on research data. "Opportunities for
full exploration of material and interchange of ideas were practically nil.
[Faculty members] need to be aware of the desire of today's students for
dynamic presentations of relevant course material on the ecology of
health."^'
By the end of the decade the school also began receiving criticism
for its neglect of public health issues in North Carolina. A 1975 self-
study characterized the period this way:
Relationships with local communities and the state had deteriorated
as departments were concerned with the federal dollar and were
worshiping the idols in Washington and Bethesda. The image of
the school in the state was not a pleasant one to contemplate because
many local health department staffs as well as the state health
department personnel felt the school's faculty were not interested in
their problems. This was also evident by the relative lack of partici-
pation by the faculty in the operations and functions of the North
Carolina Public Health Association.'*^
136
There were many reasons for this lagging interest in homegrown
issues. First and foremost, was the lack of financial support from the
state. The school's growth during the 1960s resulted from an infusion
of soft money from the federal government, and many faculty members
had no particular obligation to health agencies at the state or county
level. Their careers centered on research and service to the agencies
that gave them funding. Bill Herzog offered an example of the problems
that situation created. One of Herzog's first jobs as assistant director of
the Continued Education Service was running a six-week short course
for sanitarians. "At that point," he remembered, "the Department of
Environmental Sciences wouldn't run it, but they would participate. So
I ran the course for two or three years and worked with them to con-
vert it into an independent study course when it became more and
more difficult to get participation of the faculty in teaching the course.
The department had a person by the name of Gilbert Kelso. He kept a
very good relationship with the health people. When Gilbert left, a
significant point of contact was lost between the sanitarians in the local
health departments and the school." Justified or not, the retreat from
service to the state did little to help the school, particularly when it
came time to ask for more money for buildings.''^
Still, there were some notable exceptions. In the early 1960s, Charles
Cameron helped secure a grant from the Public Health Service for a
program in continuing education. John Wright served as director of the
Continued Education Service (reorganized into Continuing Education
and Field Service in 1969), and in 1964 Bill Herzog returned to the
school after working at the Research Triangle Institute (RTl). Herzog
spent much of his time at RTI scouting for federal money, experience
that came in very handy in his new job. "At that time continuing edu-
cation was federally financed and every time we wanted to do a short
course we would write up a short grant proposal. Writing grant proposals
had become a real art at that point, so we really took off with more
and more short courses'"*"*
The decline in service to the state was one of the issues university
Chancellor J. Carlyle Sitterson asked a study commission to examine in
1970. Bernie Greenberg chaired the commission, which included repre-
sentatives from the school's faculty and other areas of the university.
The commission recognized the enormous changes that had taken place
in the world since the end of World War II. Science and technology
had advanced at a rapid pace, and people were putting increased pres-
137
sure on government to distribute the benefits of those advances more
equitably. Public health, the commission feared, had not kept up with
these changes and, worse still, was not providing leadership in planning
for future health needs. '^^
Unlike most self-study groups, the chancellor's committee made
some far-reaching recommendations. The commission called, among
other things, for the school to "institute baccalaureate programs to serve
as a prototype for other universities and community colleges," to develop
a model community health center, and to recruit minority faculty. The
commission also suggested that the school's name should be changed to
School of Community and Public Health, to reflect the broadened con-
stituency it would serve in the 1970s.'**
The most controversial recommendation centered on an adminis-
trative restructuring that would eventually combine the Departments of
Health Administration, Health Education, Maternal and Child Health,
Mental Health, Public Health Nursing, and Public Health Nutrition
into a Department of Community Health Practices and Administration.
The reorganization of the school was necessary, the commission said,
because the present structure reflected "rather rigidly a constituency
that is no longer in the ascendency." Ta survive, the school had to adapt
more rapidly to the "changing marketplace for its product." This meant
the school needed to streamline its operations according to the wealth
and status of the departments as they stood after a decade of federal
support. Since the service-oriented departments had not fared well dur-
ing the federal funding battles of the 1960s, they should be consolidated,
thus reducing their disciplinary independence. Given the nature of the
recommendations, controversy was sure to follow.'*^
138
Dr. John Larsh (right), head of the Department of Parasitology and Laboratory Practice, confers with Polish scientist,
Dr. M. Stankievvicz, about research on trichinosis.
139
Dean Bernard Greenberg created the Division of Community Health
Service in 1972 so that the school could better serve the needs of the
state. Richard House {upper left) headed the continuing education
program from 1976-1984 and became director of the division in 1984.
Environmental consultant Linda Little {upper right) served as an adjunct
professor in the Department of Environmental Sciences and Engineering.
Howard Barnhill (lou'er right) coordinated the Area Health Education
Centers in the western part of the state. A nutrition student {lower left)
counsels a mother on the proper diet for her child as part of her field
work.
140
(T^hapter ^
PRACTICE WHAT
YOU TEACH
The 1970s was a period of remarkable contrasts. The decade
opened with popular resistance to the war in Southeast Asia
and protest movements among blacks, women, and students.
Ten years later, the nation elected one of its most conservative presi-
dents, Ronald Reagan. In between, Watergate, the oil embargo, runaway
inflation, and the Iran hostage crisis seemed to mark the end of
postwar confidence and prosperity.
Health care experienced similar ups and downs. The reformist
impulses of the 1960s carried over until mid-decade as consumers de-
manded stricter regulation, advocates for the poor and minority groups
pushed for more entitlement programs, and the environmental movement
called for tougher laws to ensure clean air, clean water, and workplace
safety. But stagflation put a break on further growth and experimenta-
tion, and by 1980 the political mood of the country turned against the
Great Society programs that had spurred the expansion of public
health programs since the 1960s.'
The School of Public Health did much soul-searching during the
1970s. A self-study committee seemed always to be in session. The
volatility of national social and political life contributed to this reflective
mood, but the school had its own problems. It had continued to grow,
even after the mid-decade financial crisis. The operating budget for
1969-70 was almost $7 million; by 1979-80 it had jumped to over $20
million. Student enrollment rose from 391 to 702 during the same period.
Faculty appointments (full- and part-time) increased from 158 to 317.
But consolidation rather than innovation was the watchword of the
decade. Dean Mayes had allowed departments to expand (or not to
expand) on their own. The result was a great imbalance in the strength
141
and resources of the departments. The 1970s demanded a more con-
certed effort at overall planning for the school.^
The school's mission also seemed unclear. Some faculty thought
that the school was governed too often by a nose for financial support
rather than a comprehensive plan for attacking the world's health prob-
lems. The status of women and minorities also caused concern. In earlier
days women had played a major role, and the school had directed
much effort toward the educational needs of blacks and American
Indians. But by the 1970s, the recruitment of women and minorities
had become a major problem.
The first problem addressed by the school was the issue of minority
recruitment. The school had long been committed to public health
training for minority groups. Until the 1960s, this commitment entailed
support for graduate programs in public health nursing and public
health education at North Carolina College in Durham. In 1960 those
programs were disbanded, and black students enrolled at the school,
albeit in relatively small numbers.
In 1970 the slow pace of integration and a general upsurge of black
activism prompted black students to issue "A Statement of Concerns
Regarding the Relevance & Responsiveness of the School of Public
Health to the Needs of Black Americans." "The situation of Blacks in
the South," the statement read, "is not unlike that of residents of de-
veloping countries. We have become increasingly cognizant of the mag-
nitude and severity of the health problems and needs of our fellow
Blacks and view this decade as a critical period for ourselves, the nation,
and institutions that wish to be a part of the solution." The students
requested increases in the number of black students and faculty, more
courses geared to the needs of students planning to work in the black
community, the appointment of a minority recruitment officer, and
greater black involvement in projects relating to the black community.^
Dean Mayes appointed a committee to consider the students' de-
mands. The committee recommended hiring a full-time minority recruiter,
and William Small eventually took the job. A student had approached
him about applying for the position. "He said 'We need someone who
knows something about public health, who has been through the school,
and who knows what it takes to get through,'" Small remembered.'*
William Small knew the school quite well. A native of Wilmington,
North Carolina, Small majored in chemistry at North Carolina College
142
frst wjl
William Small advising Rebera Foston.
and then spent a few years with the American Tobacco Company. He
returned to graduate school and received his M.S.P.H. from the Air
and Industrial Hygiene program in the Department of Environmental
Sciences and Engineering in 1969. Small was working as a chemist for
the State Board of Health when he decided to apply for the recruit-
ment position.'
"The School of Public Health was really in the forefront of efforts
to recruit minority students at the graduate level," Small remarked. "We
were the first school to hire someone full-time and go at it in a syste-
matic manner. We involved faculty, students, staff and used all kinds of
techniques to reach out into the community to attract students, and it
paid off." In the fall of 1972, less than a year after Small accepted the
job, the number of minority students increased from twenty to forty-
nine. The next year the school began to concentrate on black faculty.^
A stronger minority presence in the school highlighted the need
to make the curriculum more relevant to the needs of the black com-
munity. Concerns included white instructors' insensitivity to black
students and a lack of understanding of the complexities of black com-
munity life. A minority health conference, initiated in 1977, helped
"create a feeling of pride and understanding among the students," Small
recalled. "We felt that minority students who were training here would
be the leaders of tomorrow in the health field. They needed to know
how to get organized and put on programs. The conference was planned
and run by the students. It was learning outside the classroom."^
Increased minority recruitment was one of the many recommen-
dations made by the Chancellor's Study Commission in 1971, and it
143
boded well for the future that the school moved quickly on this issue.
By contrast, a number of factors conspired to prevent the implementa-
tion of the commission's plan for far-reaching changes in the school's
administrative structure. Little could be done until after Dean Mayes's
retirement, scheduled for 1973. Nevertheless, Dr. Dorothea C. Leighton
of the Department of Mental Health chaired a committee that began
to canvass faculty opinion on the report. Virtually no one supported
changing the school's name to the School of Community and Public
Health. "The school is community-oriented by definition," Robert Watson
of the Department of Parasitology and Laboratory Practice wrote, "why
gild the lily by stating this in the name of the school." Strong opposi-
tion to departmental reorganization also surfaced. "Consolidation of the
nutrition department with five unrelated 'service' units is a retrograde
step," wrote Department of Nutrition Chair Joseph Edozien. "Nutrition
is as much a science in its own right as are parasitology, biostatistics
and epidemiology."®
When Dean Mayes elected to step down early at the end of the
1971-72 academic year, the chancellor appointed a search committee.
But there was little question who the next dean would be. When the
committee polled the faculty, the name of Dr. Bernard Greenberg came
up time after time. "By any standard— professional competence, admin-
istrative skill, innovative practice, regard for staff well-being," Roy Kuebler
wrote, "[Bernard Greenberg] merits and receives the respect and loyalty
of all who work with him. . . .His devotion to the university and his
long intimate knowledge of its ins and outs combined with his profes-
sional and personal characteristics lead me to see him as a top ranking
nominee for our new dean."^
As a faculty member since 1949, the only chairman of the Depart-
ment of Biostatistics, and chairman of the Chancellor's Study Commis-
sion, Greenberg knew the strengths and weaknesses of the school as
well as anyone. He, John Cassel, and Dan Okun had talked for years
about how they would do things if they got the chance. Now Greenberg
had the opportunity. In brief, he envisioned a more rigorous academic
institution, dedicated to research and teaching. Greenberg was also
determined to secure a new building and to improve the school's stand-
ing in the state. In the end, the effort to acquire a building and the
rededication to North Carolina, more than academic restructuring,
guided his tenure as dean.
144
Dean Bernard Greenberg
If Washington and Bethesda had been the center of the school's
attention in the 1960s, Raleigh became the focus of the 1970s. Greenberg
surveyed the school's problems and concluded that poor relationships
with state and local health agencies constituted the school's most serious
failing. Determined to mend fences, he moved ahead on a number of
fronts. '°
Greenberg's first move was to reactivate the Alumni Association
and resume publication of The Body Politic. He believed that a strong
alumni association would keep the school in better touch with public
health practitioners, whose involvement would then increase the effec-
tiveness of the school's programs. Harriet Barr became director of public
relations for the school, with responsibility for the Alumni Association.
Barr received her M.P.H. in public health education in 1948 and re-
turned to the school in 1965 as a research associate in that department.
She was an assistant professor at the time she undertook her work in
public relations."
The school held its first annual Alumni Day in 1973, at which
time the association was formally established. A steering committee
worked out the fine points of organization over the next year, and in
145
William A. Darity
April, 1974, Dr. William A. Darity, dean of the School of Health Sci-
ences at the University of Massachusetts, became the first president.
Within a few years the Alumni Association had become a highly visible
arm of the school. The Body Politic began appearing three times a year
in 1975. Social hours at the American Public Health Association and
North Carolina Public Health Association meetings provided opportu-
nities for alumni to keep in touch with one another and with the faculty.
The Fred T. Foard Memorial Lecture, delivered by a distinguished public
health person, anchored the annual Alumni Day, and the association
established numerous awards to recognize the contributions of former
students of the School of Public Health.'^
Dean Greenberg moved to improve the school's standing among
the state's health officials by creating the Division of Community Health
Service in 1973. The division included Continuing Education, the Off-
Campus Master's Degree Program, the Area Health Education Centers,
the Technical Assistance Unit, and Field Relations. Dr. Charles Harper
directed the division and was very clear about its purpose. "Originally,
the school had a strong North Carolina focus, beginning as it did with
a continuing education program in 1936," he said. "As the school grew
in size and prestige, we responded to strong pressures from national
and international sources for training programs in public health. As a
result, the school, over time, developed an international and national
focus that overshadowed its original commitment to North Carolina.
The division's role has been to right that balance."'^
146
Senator Edmund S. Muskie deli'
the 1976 Fred T. Foard Memorial Lecture.
Dr. John Hughes assumed direction of Continuing Education.
Hughes had extensive contacts with public health officials in the state
because of his work with the Dental Health Division of the State Board
of Health. He joined the Department of Health Administration in
1966, heading the Dental Public Health Program. Under his leadership,
Continuing Education attempted to bring the latest public health knowl-
edge to professionals in the field. Through noncredit short courses and
training sessions, the unit upgraded skills that were learned in earlier
years and introduced new techniques.'''
Under Dr. Morris Schaefer's leadership, the school initiated the
Off-Campus Master's Degree Program in 1969 to allow employees of
state and local health departments to complete degree requirements on
a part-time basis while they continued to work. Students received an
M.P.H. in health administration at the end of three years. The first
program was held in Raleigh, followed by programs in Asheville in 1974
147
Lydia HoUey and Howard
Fitts attend the School
of Public Health reception
at the annual North
Carolina Public Health
Association meeting.
School faculty and alumni
became more involved in
the association in the
1970s.
and in Fayetteville in 1977. The school added a degree in public health
nursing in Greenville (1977) and Hickory (1980). '^
The Technical Assistance Unit of the division represented Green-
berg's efforts to strengthen the school's contact with state and local
health agencies. In its pure form, technical assistance involved members
of the faculty in a direct consulting role; for example, they would help
to devise a health survey for a county. But assistance also took the
form of serving on the boards of agencies, such as the North Carolina
Affiliate American Heart Association.
Another development geared to the public health needs of the
state was the bachelor of science in public health program. The training
of undergraduate public health nurses had ceased in 1962. But the
need for entry-level community health workers put pressure on the
school to resume the program. Frances Gust and Ed McGavran tried to
build a resource for the training of local public health workers by co-
operating with the newly established community college system, but to
no avail. Responding to recommendations by the Chancellor's Study
Commission and the 1972 Legislative Study Commission on Public
Health in North Carolina, the school moved to reinstitute the bacca-
laureate degree in public health. A grant from the federal government
helped establish undergraduate concentrations in biostatistics, health
administration, health education, nutrition, and environmental protec-
tion. Students entered at the beginning of their junior year.'*
The Area Health Education Center (AHEC) was a bold initiative
of national importance. Operated as a cooperative program of the Schools
148
Sarah Morrow, a School
of Pubhc Health alumna
and secretary of Human
Resources during the ad-
ministration of Governor
James B. Hunt, delivers
an address during public
health week. At right is
Jacob Koomen, Jr.,
another school alumnus
who served as State
Health Officer from
1966-1972.
of Medicine, Dentistry, Nursing, Pharmacy, and Public Health, AHEC
established educational programs in areas that lacked easy access to
major health centers. A gross imbalance in health personnel existed in
North Carolina, as in other states, and one way to right that was to
decentralize health and medical education. The regional centers provided
training for practicing professionals, course development for technical
and community colleges, and student trainees. The School of Public
Health assigned some students whose programs required field training
to the centers.'^
No sooner had Dean Greenberg embarked on these various efforts
to improve the teaching and service components of the school, than
President Richard Nixon delivered a budget message that sent shock
waves through the public health community. As part of his administra-
tion's "New Federalism," Nixon recommended termination of federal
support for schools of public health and for research training grants as
of June 30, 1973. Greenberg declared the proposed cuts would "cripple
schools of public health across the country. Some of the nation's 18
schools will almost certainly have to close if they do not receive emer-
gency funds." ^®
The school took a number of steps to meet the threatened fiscal
crisis. University officials lobbied congressmen and senators in an effort
to restore the cuts. The dean appealed to the North Carolina General
Assembly for emergency funds and to private foundations for additional
scholarships. The school also instituted some minor restructuring in an
effort to economize.
149
The School of Public Health reinstated an undergraduate degree program in 1976, as part of
Dean Greenberg's efforts to train more North Carolinians. Above, members of the Bachelor of
Science in Public Health Advisory Committee. Left to right: Craig Turnbull, Godfrey Hochbaum,
Ralph Patrick, Elizabeth Coulter, Fred Stevens, Laurel Files, and Terry Bazzarre.
Fortunately, the lobbying effort proved successful, and Congress
extended the Hill-Rhodes Act for another year. But with the financial
future anything but stable, Greenberg tried to overcome the resistance
to the reorganization recommended by the Chancellor's Study Commis-
sion. "He had a honeymoon period," Dan Okun recalled. "I said, 'do it
now. Get rid of some of those departments.' [But] he felt he couldn't
do it." Pressure from alumni and faculty in the affected departments,
Okun concluded, held Greenberg back. Others felt that the political
and personal costs of making major changes in the face of strong oppo-
sition had simply been too great. In the end, the school eliminated the
Department of Mental Health and left everything else intact. '^
The strain on schools of public health brought about by the legacy
of social and technological upheaval and the threatened funding cut-
backs was highlighted by a much-discussed report, "Higher Education
for Public Health," compiled for the Association of Schools of Public
Health by the Milbank Memorial Fund. Dr. Cecil Sheps, a former
member of the school's faculty and vice chancellor for health sciences
at the university, chaired the Milbank Commission. The commission's
thirty-four recommendations called for the "reorganization and systema-
tization" of the educational system. "What exists now is chaotic, wasteful,
and dysfunctional," Sheps wrote. "What is needed is greater clarity of
purpose to serve urgent public needs."^"
150
Vice Chancellor for
Health Affairs Cecil
Sheps and Dean Bernard
Greenberg.
The commission also stressed the need for improved leadership in
public health and urged the schools to focus their energies in that di-
rection. The commission encouraged public health faculty to become
advocates "for effective health policies, programs, and practices." Although
such actions would often "entangle them in political or otherwise con-
troversial efforts," the commission felt that the problems of the environ-
ment and in the delivery of health services required that those who
knew the most about the issues speak up.^^
Dean Greenberg and Dr. Sheps discussed some of the Milbank
Commission's early assessments in The Body Politic. Greenberg pointed
to a number of areas where the school had already moved to implement
the commission's recommendations: undergraduate training and greater
151
Roy R. Kuebler, Jr., of the Department of
Biostatistics, receives the school's first Edward G.
McGavran Award for excellence in teaching. Left
CO right: Bert Kaplan, chairman of the selection
committee. Dean Greenberg, Mary McGavran,
and Kuebler.
Dean Greenberg presents the McGavran Award in
1981 to Patricia Z. Barry of the Department of
Health Policy and Administration for her inno-
vative use of small groups in classroom teaching.
152
service to the state, for instance. But Greenberg admitted "it is a diffi-
cult process to change organizational structures within the school."
Since collapsing practice-oriented departments seemed an impossibility,
whether desirable or not, Greenberg's only choice was to strengthen
the weaker departments. In doing so, Greenberg had the help of a new
group of young department chairs who worked hard to improve the
standing of their faculty and of the school. -^^
Each of the practice-oriented departments — health education, public
health nursing, health administration, nutrition, and maternal and
child health — took a different route and developed in unique ways over
the next few years. Health administration and maternal and child
health experienced the greatest successes, although in different ways.
Thanks to increased federal support for local health agencies in
the sixties and early seventies and the rapid growth in the field of
health care, the demand for qualified health administrators far outran
the available supply. Unfortunately, the Department of Health Admin-
istration lacked the ability to train large numbers of capable administrators
when Dr. Sagar Jain assumed the chair in 1971, and the Schools of
Medicine, Business, and Public Administration competed for interested
students. Instruction suffered from the lack of faculty trained in the
Sagar Jain
153
social and administrative sciences. The department, at the time, was
made up of health clinicians — physicians, nurses, therapists. "They could
describe the health care system very well," Jain recalled. "Often they
could identify the issues on the basis of their personal observation. The
only question was how to solve them." Experience and "wisdom" sub-
stituted for methodology, Jain believed. He went to work to change
that, with the support of both Dean Mayes and Dean Greenberg.^^
Jain's own degree was in public administration, and he began hiring
people with training in operations research, finance, and economics.
Research continued to suffer, however, because of the teaching loads
and service responsibilities of these new faculty members and because
the department lacked a "critical mass" in the various disciplines. Prodded
by criticism of the department's teaching capabilities and its limited
contact with former health administrators, the school increased the
faculty in these key areas. By 1981 Jain's strategy paid off and the de-
partment changed its name to Health Policy and Administration and
began offering a Ph.D. degree.^'*
The women's movement and changing attitudes toward sexuality
heightened the public's awareness of maternal and child health issues
and increased the demand for public programs. The Department of
Maternal and Child Health benefited from this increased exposure and
grew dramatically during the seventies. The department experienced
two changes of leadership during the decade. When Earl Siegel stepped
C. Arden Miller
154
Joseph Edozien
Mildred Kaufman
down as chair in 1975, Dean Greenberg named Dr. Naomi Morris as
Siegel's replacement. As a pediatrician and public health physician,
Morris had combined clinical experience with a successful career as a
teacher and researcher. For Morris, the department's primary purpose
was to train the physicians, nurses, and social workers needed by local,
state, and national programs. But the department also had an active
research component aimed at providing a better understanding of the
problems mothers and children faced. Teenage pregnancies, delayed
child bearing, and day care were some of the issues that interested
faculty. ^^
In 1977 Dr. Morris moved to Chicago, and Dr. C. Arden Miller
took charge of the department. Miller brought extensive administrative
experience to the job, having served as dean of the University of Kansas
School of Medicine before coming to the University of North Carolina
as vice chancellor for health sciences (1966-1971).^^
Nutrition became an important national and international concern
in the 1970s, and the Department of Nutrition attracted increasing
numbers of students, faculty, and research grants. Dr. Joseph Edozien's
appointment as chair in 1971 allowed Rebecca Bryan to return to full-
time teaching and consulting. Dr. Edozien also reclaimed the department's
laboratory space and began to attract students interested in biochemical
155
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Marion Highriter
Dorothy Talbot
ir^
Elizabeth Edmands
Ann Hansen
Marie Mclntyre Julia Watkins
Some faculty members in public health nursing in the 1970s.
156
research. In fact, there was some concern by the mid-1970s that the
department had become too research oriented. ^^
The department's projects, however, often had policy implications.
The school's nutritionists, for instance, found themselves caught up in
political battles in Washington as part of their evaluation of the Special
Supplemental Food Program for Women, Infants, and Children (WIC).
The department's three-year study concluded that the supplements in-
creased the weight and the health of the infants and children in the
program and reduced anemia among mothers. "The WIC program is
one of the most important and successful of the food assistance pro-
grams," Dr. Edozien remarked. The Department of Agriculture and
President Gerald Ford were less enthusiastic, and it took a congressional
override of a presidential veto to sustain the program. ^^
By the early 1980s, education was being proposed to replace such
entitlement programs as solutions to the problem of poverty. A 1982
project headed by Mildred Kaufman of the Department of Nutrition,
with Jonathan Kotch of the Maternal and Child Health Department and
Robert Cefalo from the School of Medicine, was a case in point. The
project, funded by the March of Dimes Birth Defects Project, sought to
improve the health and nutrition of pregnant women by training health
professionals who would counsel them. Behavior modification and diet
counseling were certainly helpful in reducing infant mortality, but as
the WIC program had shown, low-income women needed more than
education to sustain a healthy diet.'^'
The Departments of Health Education and Public Health Nursing
expanded their research bases in the seventies, but preparation of front-
line practitioners and service to health agencies continued to be their
strong suit. The Department of Health Education maintained its direct
involvement with local groups through the Rural Community Environ-
mental Education Project. The environmental movement had largely
bypassed poor rural residents. Dr. John Hatch noted, and problems
such as substandard housing, improper waste disposal, poor water quality,
and fire hazards abounded. John Hatch, Ethel Jackson, and graduate
students in the department worked with residents of a rural black com-
munity in Chatham County to reduce environmental health and safety
risks. ^°
157
Ethel Jackson
John Hatch
Guy Steuart chaired the Depart-
ment of Health Education from
1969 to 1985. During that time
the department led the school in
the recruitment of minority faculty
and students. Dr. Steuart later
served as director of the Office of
International Public Health
Programs.
158
John Hatch oversaw a more ambitious education project in the
Republic of Cameroon in western Africa. Funded by a $1.9 million
grant from the U.S. Agency for International Development, the project
emphasized education and self-help as means of preventing disease and
lowering mortality. It encouraged the Cameroon government to under-
take a modernization campaign aimed at changing traditional health
beliefs and habits. The team of consultants from various departments
in the school worked with health officials to improve their understand-
ing of health issues and suggest ways of communicating this knowledge
to their countrymen.^'
Although the practice-oriented departments improved during the
1970s, the research-oriented departments — epidemiology, environmental
sciences and engineering, biostatistics, and parasitology and laboratory
practice— remained the key to the school's national standing. A center-
piece of the Department of Biostatistics's research program in the 1970s
was the Lipid Research Clinics Program. Begun in June, 1971, with a
grant from the National Heart, Lung and Blood Institute, the program
Left to right: James Grizzle, Bernard Greenberg, Dale Williams, and Michel Ibrahim work on the renewal contract for the
Lipids project.
159
measured blood fat levels in subjects at selected hospitals in the United
States, as well as in Canada, Israel, and the Soviet Union. The program
sought to determine the relationship between lipids and heart disease
and in particular to discover whether lowering cholesterol levels reduced
the risk of heart attacks and strokes. The grant established the Central
Patient Registry and Coordinating Center (CPR) at the School of Public
Health. From its offices in the NCNB building in downtown Chapel
Hill, the CPR established standard procedures for patient testing and
collected and analyzed data.^^
One of the more intriguing aspects of the program was the partici-
pation of two clinics in the Soviet Union. In 1973 James Grizzle of the
Biostatistics Department and Herman Tyroler of the Epidemiology De-
partment visited the Soviet Union to work out plans for a cooperative
United States-Soviet Union lipids research project. A few years later,
Soviet specialists began visiting Chapel Hill. "Flowering in the climate
of detente," an observer noted, "the historic collaboration has seen visiting
teams of scientists and physicians traveling back and forth . . . between
the two countries working toward the mutual goals of cutting the high
number of deaths from heart disease in both countries." ^^
In 1973 Daniel Okun stepped down as chair of the Department of
Environmental Sciences and Engineering. He was replaced by Russell F.
Christman, who came to Chapel Hill from the University of Washington.
A chemist by training, Christman, like Okun, was interested in water
quality control. Christman did not see the department as having a
direct role to play in solving environmental problems. "Our principal
goal," he explained, "is to seek through research more accurate descrip-
tions of basic environmental problems which would be useful for public
decision making."^''
By the mid-1970s, those environmental problems were immense.
During the energy crisis brought on by the oil embargo, the nation
turned to coal, nuclear power, and wood as alternative fuel sources, all
of which posed potential, but little understood, dangers to the atmo-
sphere. The pesticides and other chemicals that helped make the United
States the leading producer of food in the world also caused cancer in
farm workers and consumers alike.
The environmental movement spurred a major expansion of health-
related activities in the private sector. The federal government, through
the Environmental Protection Agency and the Occupational Health
160
Mindel Sheps
Regina Elandt-Johnson
Michael Symons
Pranab Sen
Richard Shachtman
Gary G. Koch
Some faculty members in biostatistics in the 1970s.
161
Morris Shiffman
Richard Kamens
1^ t^^ '^
Edward Kuenzler
Alvis Turner, Jr.
-JIIM
1^^
k
l-
\
1
f
Tfl
\\ <^
1
llfi
ii
Frederic Pfaender
James Lamb III
Donald Francisco
Donald Johnson
162
Parker Reisr
James Watson, Jr.
Mark Sobsey
Some members of the Department of Environmental Sciences and Engineering in the
1970s.
163
and Safety Act, required tougher health and safety standards in the
workplace, reductions in pollution levels, and safer consumer products.
To comply with these new requirements and improve public relations,
corporations began efforts to address some of their problems. This cor-
porate campaign had two effects on the school. First, departments such
as epidemiology, environmental sciences and engineering, and biostatis-
tics contracted with firms to conduct health studies and run training
programs. Second, a larger proportion of the school's graduates found
employment in industry and nonprofit organizations.
One of the more interesting consulting projects involved the school
in a cooperative venture with the United Rubber Workers Union and
major tire companies. In 1970 the discovery of a respiratory illness asso-
ciated with a chemical process in tire manufacturing spurred the creation
of the Joint Occupational Health Program involving both the union
and the tire manufacturers. The program contracted with the school to
study health problems among rubber workers. Led by Dr. David Fraser,
the Occupational Health Studies Group first conducted mortality studies
and then began investigating environmental problems in the workplace.
The long-term goal was to establish a system to monitor employees'
health and to evaluate the health risks of new manufacturing
processes.^'
The Department of Epidemiology also addressed itself to more
local concerns. In cooperation with the North Carolina Affiliate Amer-
ican Heart Association and the Tarboro Clinic, Dr. Michel Ibrahim
and Dr. Lawrence Cutchin directed a hypertension control program in
Edgecombe County. High blood pressure was a major health problem
in North Carolina, particularly among blacks and other rural people.
The program sought to identify patients suffering from hypertension
who could then be treated with different methods to determine levels
of effectiveness. The program also taught physicians new ways of en-
couraging patients to maintain their treatment regimen.^*
Under the circumstances, the school navigated the uncertainties of
the seventies well. It continued to be ranked as one of the best schools
of public health in the country, and many of its faculty members won
individual honors, highlighted by the election first of Margaret Dolan
and then of C. Arden Miller to the presidency of the American Public
Health Association. Dean Greenberg's admonition to the faculty "to
practice what you teach" proved moderately successful, and relations
164
Carl Shy
David Kleinbaum
Caroline Becker
Victor Schoenbach and Joyce Allen
Some members of the Department of Epidemiology during the 1970s.
Sherman James
165
Top: The retirement party for Gil
Clarke (center). Mrs. Clarke is at
right and Kay Cox Wijnberg on the left.
Right: Registrar Emmy Lxju Palladino
escorts Madeline Harbin at her retire-
ment party. Through an administrative
oversight, Mrs. Harbin worked at the
school until she was 80 years old.
.♦
,i
with state and local health agencies improved. The Division of Com-
munity Health Services oversaw an array of services that benefited the
delivery of health programs in the state, and the faculty served North
Carolina in many capacities in numerous organizations.
Still, problems remained. The inflationary crisis of the 1970s put a
severe strain on the university's budget. Some feared the School of
Public Health was losing ground to other institutions. "Increases in
faculty salaries have not matched inflation during the last four or five
years," the 1976 annual report declared. "Special perquisites, such as free
parking and preference in tickets to sports events, have been reduced
or eliminated. This erosion will reach a breaking point soon and when
the dam bursts, small patchwork efforts will not suffice." The lack of a
sabbatical program also made it difficult to attract and keep good faculty
and detracted from their research and instructional efforts. ^^
166
Typical office scenes
in Rosenau Hall.
Overcrowding was an
extreme problem at
the school during the
1980s.
The school's record in regard to women and minorities also needed
improvement. Despite early success in recruiting, the black presence in
the student body leveled off at 12 percent by the end of the decade.
Medical and dental schools competed more effectively for blacks in the
post-civil rights era. Moreover, the pool of qualified students increasingly
came from northern cities, and some potential students from outside
the region, black and white, hesitated to attend school in the South.
167
Efforts to recruit Native American students were even less successful. In
response, the school hired Ronald Oxendine, a Lumbee Indian from
Maxton, as director of American Indian Recruitment Services. ^^
Recruiting minority faculty proved even more difficult. The pool of
qualified candidates for most jobs was quite small, and in some fields
nonexistent. Furthermore, pressures on minority faculty once they were
at the school made it difficult to retain them. The demand for minority
members to serve on departmental, school, and university committees,
as well as minority students' need for counseling and advice, made it
difficult for them to find time for research. ^^
The relatively small percentage of women on the faculty stemmed
from structural factors, as well as from decisions by the school. In 1960,
twenty years after the school began granting graduate degrees, women
occupied roughly one-third of the faculty positions. By 1980 the pro-
portion had slipped to less than 20 percent. The Departments of Public
Health Nursing and Public Health Education accounted for the major-
ity of the 1960 positions. The presence of these programs was notable
because few schools of public health had either one. The federal gov-
Committee for the '-''•Hh dtittoral examination [ircMdcJ o\cr bv John Larsh. Standing,
left to right: Hilton Goulson, William Fleming, Norman Weatherly, John Reed. Seated,
left to right: John Feeley, doctoral candidate Sally Liska, John Larsh, and Charles Okey.
168
ernment's romance with health issues in the 1960s, however, benefited
medical and scientific endeavors — disciplines that were dominated by
men — rather than the helping professions, which were dominated by
women. Nursing, education, nutrition, and maternal and child health
lost ground to hard sciences such as epidemiology and biostatistics.
The result was an erosion of the number of women at the school.
The Jean's start, 1982. Standing, left to right: Dean Greenberg, Robert Moorhead, Harriet Barr, Ernest Schoenfeld.
Seated, left to right: Dana Quade, Robert Harris, Jr., Elizabeth Coulter, Charles Harper, William Small, Jr.
169
m.
'■■■>!
IMJ
.iL ... , .«c w. lit
c
■iSSSSsiSfc.;--
McGavran-Greenberg Hall
170
IppilogulR
The 1980s brought extensive cutbacks in federal funding for health-
related programs. At the same time the rising cost of medical
care and the growing number of uninsured families put added
pressures on the public health system in the United States. By the end
of the decade an Institute of Medicine report concluded that the
United States had "allowed the system of public health activities to fall
into disarray." As in the past, many health problems were related to
poverty, but many others cut across class and racial lines. Toxic wastes that
contaminated the water, air, soil, and food affected everyone. Drug and
alcohol abuse, AIDS, accidents, Alzheimer's disease, unwanted pregnancies,
and the aging of the population constituted the decade's most pressing
health problems.^
The School of Public Health weathered the attack on federal spending
for social services, as the state increased its contribution to the school
and the private sector invested more dollars in university-based research.
Between 1979 and 1989, the school's budget increased from $17 million
to $30 million, student enrollment from 652 to 878, and the number of
full-time faculty from 146 to 162. Growth, however, exacerbated a perennial
problem: lack of space. By 1980 faculty offices and classrooms were
scattered in eighteen separate locations across campus and in the town
of Chapel Hill, and Rosenau Hall was bursting at the seams. ^
As soon as he became dean in 1972, Bernie Greenberg began lobbying
the Division of Health Affairs, the chancellor, and the General Admin-
istration to support his request for additional space. But there always
seemed to be more urgent needs. The first good news came in January,
1980, when University of North Carolina President William Friday in-
formed Dean Greenberg that the school would receive $100,000 for the
planning of a new building. That same year the Board of Governors
gave top priority to a Public Health and Environmental Sciences building.
The architects prepared drawings and a scale model of the proposed
building, but the General Assembly did not appropriate the necessary
171
funds. When Dean Greenberg retired in 1982, his dreams of a major
expansion of the school's physical facilities had not been realized.^
University officials chose Dr. Michel A. Ibrahim, professor and
chair of the Department of Epidemiology, to succeed Greenberg. Ibrahim
had been a member of the school's community since 1960, when he
began study for an M.P.H. in biostatistics. He switched fields and took
a Ph.D. in epidemiology in 1964 before leaving for Buffalo, New "fork,
to serve on the faculty of the State University of New York at Buffalo
Medical School. In conjunction with his faculty position, he later became
first deputy commissioner in the Erie County Health Department.
Ibrahim returned to Chapel Hill in 1971 as a professor in the Department
of Epidemiology and succeeded John Cassel as chair of that depart-
ment in 1976. This combination of academic excellence, administrative
ability, and familiarity with the school made Dr. Ibrahim an outstanding
choice for the deanship.
Dean Michael A. Ibrahim
172
"When I took over" Dr. Ibrahim remembered, "the school was well
respected nationally. My job was to preserve that high standing and
improve on it if I could. One of the first things I wanted to do was get
the building for the school, because you can't achieve your mission
without proper facilities. The facilities here were very inferior compared
to other schools and other places on campus, especially the laboratories
and classrooms."'*
Dean Ibrahim, along with faculty, staff, and the school's supporters
throughout the state, went to work to secure funding for a new building.
"It was now or never," Ibrahim felt. The North Carolina General
Assembly finally approved funds for a Public Health and Environmental
Sciences building in June, 1985. Construction began in 1986, and the
125,000 square-foot building opened in the early part of 1990.^
In addition to helping secure McGavran-Greenberg Hall and the
Herman G. Baity Environmental Engineering Laboratory, Dean Ibrahim
instituted a number of important changes at the school. Between 1982
and 1989 he appointed a new chair in every department. In many cases
the search committees and the dean selected people from outside the
school. "The majority were people from the outside," Ibrahim observed,
"[but] I went for the best person. Now we have a team of fresh, new
chairs who will be looking ahead and pushing the departments and
the school to greater and better horizons."*
Although the school maintained the tradition of strong, independent
departments, complex health problems increasingly required that people
from different disciplines work together. To encourage interdisciplinary
teaching and research, which the school had deemphasized in the 1960s
and 1970s, Ibrahim established three new programs: the Program on
Health Promotion and Disease Prevention, the Office of International
Public Health Programs, and the Program on Aging. These combined
with the Institute for Environmental Studies and the Occupational
Health Studies Program to give the school vital centers for addressing
some of the most pressing health problems.
Improved teaching continued to be a primary concern for faculty
and administrators. Students of the 1980s were younger than their
counterparts of earlier years and brought less public health experience
to the classroom. They required different teaching methods and more
extensive contact with adjunct professors drawn from various health
173
The Dean's Cabinet and Statt, b'^'O. First row, left to right: Maria Salmon, Hilton
Gouison, Michel Ibrahim, Richard House, Barbara Hulka, Robert Moorhead.
Second row: Milton Kotelchuck, Ernest Schoenfeld, James Sorenson, Mildred
Kaufman, Charles Rasberry, Kerry Kilpatrick. Third row: Barry Margolin, Harriet
Barr, Donald Fox, William Small, William Glaze.
174
agencies. The Learning Resources Center (established in 1986) represented
an effort by the school to enhance teaching. The center produced a
variety of media materials for classroom use, as well as for professional
presentations and public information. It also provided faculty with
consultation on new educational and communications technologies.
Although the school paid more attention to teaching, research
continued to be the yardstick by which faculty were judged, and in that
regard the school played a leading role among schools of public health.
The scope of both basic and applied research conducted by faculty and
staff during the 1980s would have startled yet pleased the school's pioneers.
From laboratory research aimed at developing a vaccine for syphilis to
field studies seeking to reduce smoking among teenagers, the school's
research efforts covered virtually every serious public health problem. There
was continuity in many of the projects. The Lipids Research Clinics
Program continued its international collaborations on the relationship
between lipids and cardiovascular disease. A follow-up of the Evans
County, Georgia, study found a steady decline in deaths due to strokes
and heart attacks over the previous two decades. A new study of the WIC
nutritional program included faculty from a number of departments.
But many new health problems, such as radon, AIDS, magnetic field
exposure, and eating disorders, also received attention by researchers.
Smoking was probably the most sensitive public health issue in
North Carolina during the 1980s, and the school took the lead in analyzing
the effects of tobacco and in developing ways to help people quit
smoking. In the school's early days tobacco was an accepted part of daily
life: Rosenau kept a pipe at his side and Dean McGavran was rarely
without a cigarette. But by 1989, the school no longer permitted smoking
in any of its buildings. Spurred on by the antismoking campaign of
Surgeon General C. Everett Koop, researchers associated with the school
worked to develop new methods for breaking the tobacco habit. One
such program focused on blacks, who, by the late 1980s, had smoking rates
above the national average and as a result had higher incidences of
heart disease and lung cancer. School researchers were not unmindful
of the economic impact of reduced tobacco consumption on the state's
farmers and also studied ways to ease farmers' dependence on the crop.
Public service remained an important component of the school's
overall mission, and the school maintained the ties to state and local
175
health agencies built during the 1970s. But in addition to the county
health departments, in the 1980s the school gave assistance to voluntary
health organizations, schools, local environmental agencies, and cor-
porations. To adapt to this changing constituency and to improve the
school's service efforts and to communicate them to the general public,
Dean Ibrahim established the School of Public Health Board of Ad-
visors in 1985. Members represented civic and advocacy groups, vol-
untary health organizations, professional associations, and various govern-
ment agencies.^
As the school approached its golden anniversary, it began planning
for the future. With the support of Dean Ibrahim, the school developed
a strategic planning process. Begun as a loosely structured discussion
among administrators and faculty in 1986, the process became more
formalized the next year with the appointment of a Strategic Planning
Committee headed by Arnold Kaluzny, professor of Health Policy and
Administration. The size and diversity of the school required a more
systematic approach to growth than had prevailed in the past. The
faculty could no longer hash out ideas over lunch in the dean's office.
Rapid technological changes and uncertain political developments also
necessitated more careful forays into the future.
The committee defined strategic planning "as a continuous process
conducted by the leadership of the school in order to identify important
school-wide issues, analyze these issues from the perspective of existing
and future environmental forces and organizational characteristics, and
develop mechanisms for their resolution." Although similar to past patterns
of dealing with critical issues, the new process structured planning into
the everyday life of the school.^
As a start the committee solicited the opinions of the faculty and
outside evaluators on the critical issues facing the school. Not unex-
pectedly, the faculty focused on improving the educational environment
at the school — the need to attract high quality faculty and students, the
need for improvements in the curriculum, the need for space and support
services— while outsiders emphasized the need for the school to expand
its involvement with state and local health agencies. All parties agreed
that the school had to continue to find ways of addressing serious con-
temporary health problems.
In identifying the issues the planning process should address, the
committee confronted a host of institutional and social issues. It was a
176
Long a leader in the use of
computers for scientific work,
in 1982 the school led the way
into the office automation era
by installing a mini-computer
for word processing, electronic
mail, and other office and
administrative tasks. Above,
Russell Christraan receives in-
struction from his administrative
assistant, Maggie Schimert, on
the use of electronic mail.
Belou; Harvey Jeffries, who was
instrumental in establishing
the new system, confers with
Operations Manager Robert
Middour.
177
question of which problems were paramount and the manner in which
the school could best organize itself to address and solve them. There
were dozens of institutional issues that had no direct relation to the
larger health concerns, but which were of critical importance if the
school were to accomplish its mission. The committee decided to focus
on problems facing the school and identified eight issues for the planning
process to address: departmental versus school mission; the School of
Public Health's administrative and financial structure; the appropriate
balance between education, research, and service; public education
about health; policy development and advocacy; research dissemination;
student enrollment; and continuing education.
The highlight of the strategic planning process was an afternoon
and evening retreat attended by 117 faculty members in March, 1989.
For the first time in almost forty years, the faculty formally sat down
to discuss the school's purpose and direction. The issues were not that
different from the discussions instigated by Dean McGavran in the early
1950s, and as always the faculty expressed a wide range of opinions.
There was general consensus that the committee had raised important
questions, but there was also an understanding that there were no
simple answers.
As it planned for the future, the School of Public Health could
take pride in the many accomplishments of its first fifty years. From its
beginnings in 1936 as a division of the Medical School, it had emerged
as one of the outstanding schools of public health in the world.
Thousands of students had left the school for jobs in private and public
health agencies in every state and in numerous foreign countries. Their
contributions, and those of the faculty, in basic and applied research
and in the improvement of the health of people around the world were
incalculable.
The school's success can be attributed in large part to the breadth
of its scientific and educational undertakings and its flexible response to
changes in the public health agenda. The school was blessed with out-
standing leaders — administrators, educators, and scientists. These men
and women came from numerous disciplines — engineering, education,
biomedical research, administration, and statistical analysis— to build a
school with a wide range of research and educational activities. Adherents
of an administrative and social reform philosophy of the health movement
worked side-by-side (though not always seeing eye-to-eye) with propo-
nents of a more scientifically oriented model. The University of North
178
Carolina was the first school of public health to train all members of
the public health team: public health nurses, health educators, biosta-
tisticians, sanitary engineers, nutritionists, and epidemiologists.
This makeup insured a student body with diverse interests and ex-
pectations. The short courses of the late 1930s helped the employees of
southeastern health departments better perform their duties as health
officers, sanitarians, and engineers. The public health nurses and health
educators who filled the classrooms during the 1940s and early 1950s
staffed growing state and local health agencies. The training of front-line
health practitioners declined over the years as more students prepared
for administrative, research, and teaching positions. But off-campus and
continuing education programs helped keep practitioners up to date.
As the school approaches its fiftieth anniversary, it can celebrate the
realization of Dr. Rosenau's dream of developing a "real" school of
public health. But Rosenau's other dream, "of a time when . . .every man
shall possess sufficient for the needs of his body and the demands of
health," has proved more illusive. Despite a century of extraordinary
progress, serious public health problems — some old, some new— continue
to plague the state, nation, and world. Infant mortality rates in North
Carolina are the highest in the country; AIDS has reached epidemic
proportions in parts of the United States; and millions of people around
the globe suffer from malnutrition. In attempting to address the problems
of the 1990s, health officials will be plagued by the same situation that
led to the founding of the School of Public Health in the 1940s, the
shortage of trained health workers. Even today the majority of public
health practitioners lack formal training.
The School of Public Health cannot solve the state's (or the
world's) problems by itself. Poverty, ignorance, and governmental
neglect continue to impede the creation of a healthy society. Still, if
progress is to be made, the school must remain dedicated to finding
solutions to today's health problems, educating the public about means
of disease prevention, and advocating increases in social expenditures
for health. Dr. Rosenau's credo can provide a guidepost for the next
half century. "When young men have vision, the dreams of old men
come true."
179
CHAPTER 1
1. Carl V. Reynolds to Rosemary M. Kent, July 30, 1962, School of Public Health
Records, University of North Carolina Archives, University of North Caro-
lina, Chapel Hill (hereafter cited as SPH).
2. C. S. Mangum to Milton J. Rosenau, September 26, 1935, SPH.
3. Milton J. Rosenau to A. S. Rose, September 29, 1939, SPH.
4. Milton J. Rosenau, Curriculum Vitae, SPH.
5. George Rosen, A Histor.' of Public Health (New York: MD Publications, 1958),
201.
6. Rosen, A History of Public Health, 278, 287-90; Paul Starr, The Social Transfor-
mation of American Medicine (New York: Basic Books, 1982), 181; Barbara
Rosenkrantz, Public Health and the State: Changing Views in Massachusetts,
1842-1936 (Cambridge; Harvard University Press, 1972), 97-127; Elizabeth Fee,
Disease and Discovery: A History of The fohns Hopkins School of Hygiene and
Public Health, 1916-1939 (Baltimore: The Johns Hopkins University Press,
1987), 13.
7. Rosen, A History of Public Health, 294; Fee, Disease and Discovery, 22.
8. Fee, Disease and Discovery, 14-22.
9. Benjamin E. Washburn, A History of the North Carolina State Board of Health,
1877-1925 (Raleigh, N. C: North Carolina State Board of Health, 1966),
8-22.
10. Washburn, History of N. C. Board of Health, 38.
11. Washburn, Histoo' of hi. C. Board of Health, 41-2; J. W Roy Norton and
Benjamin Drake, "History of Public Health in North Carolina," in Essays in
the History of Medical Science and Medical Service, 1524-1960, vol. II, ed. Dorothy
Long (Raleigh, N. C: The North Carolina Medical Society, 1972), 593.
12. Quoted in Allen Tullos, "The Great Hookworm Crusade," Southern Exposure 6
(1978): 41; James Leloudis, "'A More Certain Means of Grace': Pedagogy, Self,
and Society in North Carolina, 1880-1920" (Ph.D. diss., University of North
Carolina at Chapel Hill, 1989), 293-300. Also see John Ettling, The Germ of
Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge:
Harvard University Press, 1981) for an analysis of the hookworm campaign.
13. Washburn, History of N. C. Board of Health, 46-9.
14. Washburn, History of N. C. Board of Health, 48.
15. Fee, Disease and Discovers, 28.
16. Steven C. Wheatley, The Politics of Philanthropy: Abraham Flexr\er and Medical
Education (Madison: The University of Wisconsin Press, 1988), 57-107; Fee,
Disease and Discovery, 29-30.
17. Fee, Disease and Discovery, 37-40.
18. B. E. Washburn, As / Recall: The Hookworm Campaigns Initiated by the Rocke-
feller Sanitary Commission and the Rockefeller Foundation in the Southern United
States and Tropical America (New York: The Rockefeller Foundation, 1960), 15,
111-181.
19. B. E. Washburn, "Report on Proposed Cooperation for Training Public Health
Workers Between the State Board of Health and the University of North
Carolina," [1919], North Carolina State Board of Health Records, Division of
Archives and History, Raleigh, North Carolina (hereafter cited as NCSBH);
"Tentative Report from the North Carolina Board of Health to the University
of North Carolina Regarding the Establishment of a Post Graduate Course of
Study for Health Officers and Public Health Nurses," March 17, 1919, Univer-
sity Papers, University of North Carolina Archives, University of North
Carolina, Chapel Hill (hereafter cited as University Papers).
20. H. W Chase to W. P Jacocks, April 30, 1919, University Papers.
21. Washburn, History of hi. C. Board of Health, 53; Washburn, "Report on Proposed
Cooperation for Training Public Health Workers Between the State Board of
Health and the University of North Carolina" and William deB. MacNider to
H. W Chase, November 7, 1919, University Papers.
22. Washburn, History of N. C. Board of Health, 72-3.
23. Bidletin of the 'North Carolina State Board of Health 37 (January 1922): 3-11.
24. Biennial Report, North Carolina Board of Health (1936-38) (Raleigh, N. C:
North Carolina Board of Health, 1938), 22-25.
25. Report on a Survey of the Organization and Administration of the State Government
of North Carolina (Washington: The Brookings Institution, 1930), iv, 176-90.
26. Biennia; Report (1936-38), 25-29.
27. James M. Parrott to John A. Ferrell, July 16, 1931; John A Ferrell to James M.
Parrott, July 20, 1931; James M. Parrott to John A. Ferrell, July 24, 1931; John
A. Ferrell to James M. Parrott, July 28, 1931, Record Group 2, Series 236,
Rockefeller Foundation Archives of the Rockefeller Archive Center, Pocantico
Hills, North Tarrytown, New York (hereafter cited as RFA).
28. H. G. Baity to Frank P. Graham, February 1, 1932, Office of the President
Records, Frank Porter Graham Series, University of North Carolina Archives,
University of North Carolina, Chapel Hill (hereafter cited as Graham Series).
29. Memorandum by John A. Ferrell, March 24, 1932, RG 2, Ser. 236, RFA.
30. Daniel Singal, The War Within: From Victorian to Modernist Thought in the
South, 1919-1945 (Chapel Hill: University of North Carolina Press, 1982),
115-152, 265-301.
31. Albert Coates, The Story of the Institute of Goiemment: the University of North
Carolina at Chapel Hill (Chapel Hill: n.p., 1981), 27-8.
32. Howard W Odum to Frank Graham, May 21, 1931; W C. Jackson to Frank P.
Graham, January 8, 1934, Graham Series.
182
ii. Carl V. Reynolds to Charles S. Mangum, July 10, 1935, "Plan for Educational
Unit in the Field of Public Health in the University of North Carolina,
School of Medicine"; C. S. Mangum to M. V. Ziegler, March 18, 1935,
NCSBH.
34. Committee on Economic Security, Report to the President of the Committee on
Economic Security (Washington: United States Government Printing Office,
1935), 38-41.
35. Edwin E. Witte, The Development of the Social Security Act (Madison, Wisconsin:
The University of Wisconsin Press, 1963), 171-2; Roy Lubove, "The New Deal
and National Health," Current History 45 Ouly 1963): 83.
36. Memorandum by M. V. Ziegler, December 27, 1935, Office of the Chancellor:
R. B. House Series, University of North Carolina Archives, University of
North Carolina, Chapel Hill (hereafter cited as House Series).
1. Frank P. Graham to Milton J. Rosenau, December 30, 1935, Graham Series;
"State Is Slated to Get Regional Health School," hlews and Observer, January 7,
1936; Matthew S. Broun to Frank P. Graham, January 22, 1936, Graham
Series. See also C. C. Hudson to Milton J. Rosenau, January 16, 1936, SPH.
2. C. S. Mangum to Frank P. Graham, February 5, 1936, Graham Series; "Rosenau
on Epidemics," The Chapel hlill Weekly, February 14, 1936; "Rosenau Speaks
on Epidemiology," The Daily Tarheel, February 6, 1936.
3. M. J. Rosenau to R. B. House, December 18, 1936, House Series.
4. Jean Alonzo Curran, Founders of the Harvard School of Public Health, with Bio-
graphical >^otes, 1909-1946 (New York: Josiah Macy, Jr. Foundation, 1970), 28;
Fee, Disease and Discovery, 88-9.
5. M. J. Rosenau to C. S. Mangum, April 28, 1936, SPH.
6. Charles M. Weiss, "An Historical Outline of the Department of Environmental
Sciences and Engineering," (Chapel Hill: School of Public Health, 1967, mime-
ographed), 1.
7. M. J. Rosenau to Frank P. Graham, June 6, 1936, Graham Series; Albert
Coates, "A Portrait in Words," in Presentation of the Herman G. Bait7 Portrait to
the University of hlorth Carolina (Chapel Hill: School of Public Health, [1966]),
7-9.
8. A. Worth Petty, interview with author, Virginia Beach, Va., November 10,
9. Petty interview.
10. Petty interview; Minutes of Administrative Board of the Division of Public
Health, November 13, 1936, SPH.
11. M. J. Rosenau to Charles S. Mangum, September 12, 1936, SPH; Frank P.
Graham to Charles S. Mangum, June 18, 1936, SPH; Frank P. Graham to
Charles S. Mangum, W. deB. MacNider, M. J. Rosenau, Herman G. Baity,
and W. R. Berryhill, March 22, 1937, SPH.
183
12. "University of North Carolina Public Health and Medical School Project,"
March, 1937, SPH,
13. H. G. Baity to Raymond J. Rosenberger, June 12, 1937; H. G. Baity to Milton
J. Rosenau, June 25, 1937, SPH.
14. M. J. Rosenau to R. B. House, March 3, 1938; R. B. House to M. J. Rosenau,
March 7, 1938, SPH.
15. John Larsh, interview with author, Edenton, N. C, October 3, 1988; M. j.
Rosenau to A. S. Rose, October 27, 1937, SPH.
16. M. J. Rosenau to My Friends, September 25, 1939, SPH; memorandum by
William A. Mcintosh, December 4, 1939, RG 2.1, RFA.
17. Emil Chanlett, interview with author, Chapel Hill, N. C, October 26, 1988;
Thomas J. Brooks, Jr., "Reflections," The Body Politic 4 (Summer 1976): 3.
18. Fee, Disease and Discovery, 42; Record of Faculty Meeting, February 10, 1940,
SPH; R. B. House to M. J. Rosenau, June 15, 1940, Graham Series.
19. Allan Brandt, No Magic Bullet: A Social History of Venereal Disease in the
United States Since 1880 (New York: Oxford University Press, 1985), 6.
20. Bryan Haislip, A History of the Z. Smith Reynolds Foundation (Winston-Salem,
N. C: John F Blair, Publisher, 1967), n.p.; "Enormous Sum is Given State for
Battle Against Syphilis," hJews and Observer, December 19, 1937.
21. M. J. Rosenau to R. B. House, October 3, 1939; J. E. Moore to Wm. deB.
MacNider, June 19, 1939, SPH.
22. "A Study in the Epidemiology of Syphilis, Orange, Person, Chatham Counties,
North Carolina," July 1, 1940, to December 31, 1940, n.d., 3; "Summary of the
Activities of the Field Epidemiological Study of Syphilis in the Orange-
Chatham-Person Health District and the City of Durham and Durham
County During the Year 1942," n.d., SPH.
23. E. A. Kelley, Bessie Baker, Ruth Council, and Bessie M. Chapman to Frank P.
Graham, August 23, 1937; M. J. Rosenau to R. B. House, December 6, 1937;
Record of Faculty Meeting, December 9, 1939; Carl V. Reynolds to M. V.
Ziegler, April 17, 1940, SPH.
24. M, J. Rosenau to R. B. House, November 18, 1940, SPH.
25. Ruth W. Hay to M. J. Rosenau, September 11, 1940, SPH.
26. Harriet H. Barr and Helen Hanken, comps.. Health Education: Selected Papers
of Lucy Morgan (Chapel Hill: School of Public Health, 1986), ix-xii.
27. Lucy S. Morgan, interview with author, Asheville, N. C, December 19, 1988;
Lucy S. Morgan, "Health Education in Extra-Cantonment Zones," in Health
Education, Barr and Hanken, 10-13.
28. H. W. Brown to R. B. House, August 25, 1942, SPH.
29. Eunice N. Tyler and Lucy S. Morgan, eds.. Health Educators at Work, Special
Issue (May 1966): 41.
30. Morgan interview.
31. H. W. Brown to R. B. House, August 31, 1942, SPH.
32. Harold B. Gotaas, "Cooperative Health and Sanitation in the Americas,"
School of Public Health News 1 (Summer 1946): 3.
184
CHAPTER 3
1. M, J. Rosenau to W. K. Sharp, September 7, 1945, SPH.
2. Shepard is quoted in Ida Jenkins Gadsden, "The Historical Development and
Social Implications of the Public Health Education Program at North Carolina
College at Durham" (Ph.D. diss.. University of North Carolina at Chapel Hill,
1968), 66. The most complete history of the program is Gadsden's. See also B.
T McMillon, "North Carolina College Makes Health Training Functional,"
The High School ]oumal 32 (1949): 217-219; Tyler and Morgan, Health Educators
at Work, Special Issue, 59-62.
3. Morgan interview, Larsh interview.
4. Dorothy M. Talbot, "A History of the Public Health Nursing Program in the
School of Public Health, University of North Carolina at Chapel Hill," (type-
script in author's possession), 18-20.
5. Memorandum by E. W. McHenry, March 8, 1946, General Education Board
records. Series 1, Subseries 3, Box 539, Folder 5769, Rockefeller Archive Center.
6. Edward H. Beardsley, A History of hleglect: Health Care for Blacks and Mill
Workers in the Twentieth-Century South (Knoxville: The University of Tennessee
Press, 1987), 273-309.
7. Larsh interview.
8. Morgan interview. See Gadsden, "The Public Health Education Program at
North Carolina College at Durham," 12.
9. Rosemary M. Kent, "The Moment Between the Past and the Future," (type-
script in author's possession), 25-6.
10. James S. Simmons to Frank P. Graham, January 24, 1946, SPH.
11. M. J. Rosenau to A. R. Mann, November 8, 1945, House Series.
12. "A. H. Bryan Heads New Department of Nutrition," School of Public Health
News 2 (Winter 1946): 1.
13. H. G. Baity to R. B. House, May 15, 1946, SPH.
14. H. G. Baity to E. G. McGavran, March 1, 1947, Personnel File, Dean's Office,
School of Public Health, University of North Carolina at Chapel Hill (here-
after cited as Personnel File).
15. Harriet H. Barr and Frances H. Barrie, Edward G. McGavran: Guardian of the
Body Politic (Chapel Hill: The School of Public Health, 1979), 7-16.
16. E. G. McGavran, Report to the Eaculty (Chapel Hill: School of Public Health,
1963), n.p.
17. "Proposed Field Training Program of the School of Public Health," n.d.; M. R.
Kinde to E. G. McGavran, May 21, 1948, SPH.
18. "W. P. Richardson Heads New Department," School of Public Health News 3
(Summer 1948): 1.
19. Harold J. Magnuson to E. G. McGavran, February 7, 1950, SPH; "Syphilis
Experimental Laboratory," School of Public Health News 4 (Summer 1949):
1-2.
20. Edward G. McGavran to R. B. House, July 30, 1948, SPH.
21. Barr and Barrie, Guardian of the Body Politic, 26-7.
22. Paul F. Whitaker and Frederick C. Hubbard, "The History of the North
Carolina Medical Care Commission," in Essays in the History of Medical Science
and Medical Service, 1524-1960, vol. I, ed. Dorothy Long (Raleigh, N. C: The
North Carolina Medical Society, 1972), 330-49. For a discussion of this process
on a national and international level see Daniel M. Fox, Health Policies,
Health Politics: The British and American Experience, 1911-1965 (Princeton, New
Jersey: Princeton University Press, 1986), 115-131, 149-168.
23. For McGavran's views on the Division of Health Affairs at the time of his
retirement, see E. G. McGavran to William Aycock, June 4, 1963, Office of
the Chancellor: W. B. Aycock Series, University of North Carolina Archives,
University of North Carolina, Chapel Hill.
24. For a discussion of national postwar health policy see Starr, American Medicine,
347-363.
25. Fox, Health Policies, 153-8.
26. Edward G. McGavran to R. B. House, July 30, 1948, SPH.
27. H. E. Handley, Visit to the University of North Carolina School of Public
Health, December 1-2, 1949, n.d., Commonwealth Fund records. Rockefeller
Archive Center, p. 2.
28. Cecil Sheps, interview with author. Chapel Hill, N. C, November 4, 1988.
29. John J. Wright to Lowell J. Reed, December 19, 1945, SPH.
30. Report of Activities of the Department of Maternal and Child Health in the
School of Public Health of the University of North Carolina, Under a Joint
Project with the North Carolina State Board of Health and Sponsored by the
Children's Bureau, n.d., SPH.
31. "Department of Mental Health," in School of Public Health Annual Report,
1951-52 (Chapel Hill: School of Public Health, 1952), 1-3.
32. Rebecca Broach Bryan, interview with author. Chapel Hill, N. C, March 18,
1989.
33. Frances Gust, interview with author, North Myrtle Beach, S. C, June 21, 1989.
34. Geraldine Gourley, interview with author, Chapel Hill, N. C, August 31, 1989.
35. Gourley interview.
36. "Toward New Horizons," The High School Journal 30 (May 1947): 113.
37. Harcourt Morgan's philosophy is best expressed in Ellis F. Hartford, Our
Common Mooring (Athens: The University of Georgia Press, 1941).
38. School of Public Health Annual Report, 1951-1952 (Chapel Hill: School of Public
Health, 1952), 11, 14.
39. Edward G. McGavran, "What Is Public Health?", Canadian Journal of Public
Health 44 (December, 1953): 441-451.
40. Ibid., 445-7.
41. Memorandum by Dean McGavran to Faculty, December 9, 1952, SPH.
186
CHAPTER 4
1. Starr, American Medicine 347.
2. Daniel Okun, interview with author, Chapel Hill, N. C, September 23, 1988.
3. Department of Sanitary Engineering, Sanitary Engineering in Peru (Chapel Hill:
School of Public Health, n.d.), 19; "UNC School of Public Health in Peru,"
The Body Politic 3 (May 1957): 1.
4. Department of Sanitary Engineering, Sanitary Engineering in Peru, 20.
5. Lucy S. Morgan and Hiawatha B. Walker, "A University's Focus on Indian
Health," Health Educators at Work 11 Qune 1960): l-Il.
6. Joe Fred Sills and Gilbert Trujillo, "Zuni — Center of the World — Reaches Out,"
Health Educators at Work II Qune I960): 25-32.
7. Starr, American Medicine, 343.
8. Goulson interview; Bryan interview.
9. Department of Biostatistics, "Report for the Year, July I, 1951-June 30, 1952,"
in Annual Report, 1951-1952, 4.
10. Ibid.
11. Tyler and Morgan, Health Educators at Work, Special Issue, 30; McGavran,
Report to the Faatlty, n.p.
12. Gourley interview.
13. Department of Epidemiology, "Annual Report, 1953-54," in School of Public
Health Annual Report, 1953-1954 (Chapel Hill: School of Public Health, 1954), 3.
14. John Cassel to E. G. McGavran, October I, 1958, Personnel File.
15. School of Public Health Annual Report, 1958-1959 (Chapel Hill, School of
Public Health, 1959), n.p.
16. E. G. McGavran to Sidney L. Kark, June 29, I960, Personnel File.
17. Michel Ibrahim, interview with author. Chapel Hill, N. C, June 6, 1989.
18. Roger W. Howell to Edward G. McGavran, September 20, 1956, Personnel File.
19. The Ruth W. Hay Portrait Committee to E. G. McGavran, August 9, 1954,
Personnel File.
20. Margaret B. Dolan, Curriculum Vitae, Personnel File.
21. Bryan interview.
22. Hilton Goulson, interview with author. Chapel Hill, N. C, July 12, 1989;
Larsh interview.
23. Goulson interview; Larsh interview.
24. Larsh interview.
25. Larsh interview.
26. Okun interview.
27. McGavran, Report to t/ie Faculty, n.p.; Okun interview.
28. "Construction to Start on New P H. Building," The Body Politic 5 (May 1959): 5.
29. The letter included an editorial in support of the bond vote from The Chapel
Hill Weekly, October 5, 1959, detailing the school's inadequate facilities.
187
30. School of Public Health Annual Report, 1959-1960 (Chapel Hill, School of Public
Health, 1960), 5.
31. E. G. McGavran, "Testimony Before the Committee on Interstate and Foreign
Commerce Relative to the Proposed Bill H.R. 4998 (S. 1071) for Community
Health Facilities and Services," May 4, 1961, SPH.
32. Rosemary Kent, This Moment Between the Past and the Future (Chapel Hill:
School of Public Health, n.d.), n.p.
33. School of Public Health, "Self-Study Report," January 15, 1963, SPH, v-6.
34. Ibid., x-2.
35. McGavran, Report to the Faculty, n.p.
36. Goulson interview.
37. Past, Present, and Future of Schools of Public Health (Chapel Hill: School of
Public Health, 1963).
1. Starr, American Medicine, 367.
2. John E. Larsh, Jr., to Henry T. Clark, May 22, 1963, Vice Chancellor for
Health Affairs, University of North Carolina Archives, University of North
Carolina, Chapel Hill.
3. W. Fred Mayes, Curriculum Vitae, Personnel File.
4. School of Public Health Annual Report, 1961-1962 (Chapel Hill: School of Public
Health, 1962), 4; School of Public Health Annual Report, 1972-1973 (Chapel
Hill: School of Public Health, 1973), 21.
5. Weiss, "Historical Outline," 4.
6. Daniel A. Okun, "The History of the Institute for Environmental Studies,"
mimeograph, June, 1977, SPH.
7. ESE Notes 3 (April 1966): 1; ESE Notes 4 Qanuary 1967): 1; ESE Notes 6 Quly
1969): 1.
8. "Department of Biostatistics, UNC," mimeograph, November, 1974, SPH.
9. "Department of Biostatistics," in School of Public Health, Annual Report, 1966-1967
(Chapel Hill: School of Public Health, 1967), 6, 29.
10. A Guide to the Carolina Population Center and its Affiliated Programs (Chapel
Hill: Carolina Population Center, University of North Carolina at Chapel
Hill, 1975).
11. Bernard Greenberg, "Memorial Speech for Dr. John C. Cassel," October 31,
1976, SPH.
12. John C. Cassel, "Summary of Major Findings of the Evans County Cardio-
vascular Studies," Archives of Internal Medicine 128 (December 1971): 881-9.
13. Greenberg, "Memorial Speech for Dr. John C. Cassel."
14. Larsh interview; Goulson interview.
15. Okun interview.
188
16. Okun interview.
17. William Herzog, interview with author, Chapel Hill, N. C, July 13, 1989.
18. Starr, American Medicine, 370.
19. W. Fred Mayes, "Personal Introduction -A Statement of Intentions and E.xpec-
tations," September 17, 1963, SPH.
20. In 1967, the school also established an administrative board to comply with
university policy, and the next year adopted a written constitution and bylaws.
21. Robert B. Moorhead, "Formal Goal Formulation in a School of Public Health"
(M.P.A. thesis. University of North Carolina at Chapel Hill, 1972), 86.
22. Morgan interview.
23. J. Carlyle Sitterson to W. Fred Mayes, June 7, 1966; W. Fred Mayes to J.
Carlyle Sitterson, June 22, 1966, Office of the Chancellor: J. C. Sitterson
Series, University of North Carolina Archives, University of North Carolina,
Chapel Hill.
24. Elizabeth Lovell McMahan, "A Study of the Department of Public Health
Education, School of Public Health, University of North Carolina" (Ph.D.
diss., Duke University, 1968), 269-82.
25. Memorandum by William Fred Mayes, January 3, 1969, SPH; Guy W. Steuart
to Dean Mayes, August 24, 1971; Hiawatha B. Walker to Guy W. Steuart,
July 30, 1971, SPH.
26. Herzog interview; Sagar Jain, interview with author. Chapel Hill, N. C, Sep-
tember 8, 1989.
27. Department of Public Health Administration, "Annual Report, 1966-67," in
School of Public Health Annual Report, J 966-67 (Chapel Hill: School of Public
Health, 1967), 1-2.
28. Goulson interview.
29. Talbot, "History of Public Health Nursing," 32-4.
30. Ibid., 37-41.
31. Margaret Dolan to Charles Harper, August 24, 1966, Personnel File; Talbot,
"History of Public Health Nursing," 45-7.
32. Weiss, "Historical Outline," 7.
33. John C. Cassel to Fred Mayes, November 5, 1964, SPH.
34. Gourley interview.
35. William Fred Mayes, The University oj hlorth Carolina School of Public Health
Relates to the hleeds of a Changing Society: A Selective and Interpretive Account
with Emphasis on the Decade of the Sixties (Chapel Hill: School of Public
Health, 1975), 53-4.
36. The SPH could look proudly at its own record in the black community and
with black students. W. Fred Mayes to J. Carlyle Sitterson, February 24, 1969,
SPH.
37. Gourley interview.
38. Herzog interview.
39. "Report of Temporary Committee on Student Organization of School of Public
Health," n.d., SPH.
189
40. Jane Mathews, "Convocation Message," September 16, 1970, SPH.
41. PUBH Students to W. Fred Mayes, February 9, 1970, SPH.
42. School of Public Health "Self-Study Summary Report," (Chapel Hill, School of
Public Health, 1975, Mimeographed), 372.
43. Herzog interview.
44. Herzog interview.
45. University of North Carolina at Chapel Hill, "Report of Chancellor's Study
Commission on the Role of the School of Public Health," (Chapel Hill:
University of North Carolina, 1971, Mimeographed), 7-14.
46. Ibid., 4.
47. Ibid., 63.
CHAPTER 6
1. Starr, American Medicine, 380.
2. School of Public Health Annual Report, 1969-1970 (Chapel Hill, School of Public
Health, 1970), n.p.; School of Public Health Annual Report, 1979-1980 (Chapel
Hill, School of Public Health, 1980), 17,26,45.
3. "A Statement of Concerns Regarding the Relevance & Responsiveness of the
School of Public Health to the Needs of Black Americans," [1971], SPH.
4. William T. Small, interview with author. Chapel Hill, N. C, August 24, 1989.
5. Small interview.
6. Small interview.
7. Small interview; Minority Student Group to B. G. Greenberg, November 6,
1972, SPH.
8. John E. Larsh to Dorothea C. Leighton, June 15, 1972; Joseph C. Edozien to
Dorothea C. Leighton, September 29, 1972, SPH. For an overview of the
faculty's response to the report see Cecil G. Sheps, "The University of North
Carolina School of Public Health," in Schools of Public Health: Present and
Future, eds., John Z. Bowers and Elizabeth F. Purcell (New York; Josiah Macy,
Jr. Foundation, 1974), 72-8.
9. Roy R. Kuebler to Emil T. Chanlett, January 10, 1972, SPH.
10. School of Public Health, "Self-Study Summary Report," 358-63.
11. Harriet H. Barr, Curriculum Vitae, Personnel File.
12. "Alumni Association," The Body Politic 1 Ganuary 1973): 19; "A First: SPH
Alumni Day 1973," The Body Politic 1 Oune 1973): 1; "Darity Heads Alumni
Association," The Body Politic 2 (August 1974): 1.
13. Charles L. Harper, "An Outreach Approach to Service," The Body Politic 6
Oune 1979): 5.
14. "Highlighting Continuing Education," The Body Politic 1 (June 1973): 5; John
Hughes, Curriculum Vitae, Personnel File.
15. Janice Westaby directed the program from 1969 to 1973, Lydia HoUey from
1973 to 1974, and Bill Herzog until 1982.
190
16. Gust interview; "Bachelors Program Initiated in Public Health" The Body
Politic 4 (October 1976): 16.
17- Dr. Cecil Slome and Howard Barnhill coordinated the program initially. "Area
Health Education Centers Established," The Body Politic 1 (June 1973): 11.
18. "Dean Discusses School's Future," The Body Politic 1 (June 1973): 1.
19. Okun interview.
20. Cecil G. Sheps, Higher Education for Public Health: A Report of the Milbank
Memorial Fund Commission (New York: Prodist, 1976), 211.
21. Ibid., 153.
22. B. G. Greenberg, "The Crisis in the Schools of Public Health: The Response,"
The Body Politic 2 (August 1974): 11.
23. Jain interview.
24. Jain interview; "A Conversation with Sagar Jain," The Body Politic 6 (January
1979): 1.
25. "Morris Heads Maternal and Child Health," The Body Politic 3 (November
1975): 4; Naomi M. Morris, "Child Advocacy a Major Role for MCH," The
Body Politic 4 (October 1976): 1.
26. C. Arden Miller, Curriculum Vitae, Personnel File.
27. Memorandum by Review Committee of the Chairman of the Department of
Nutrition, April 9, 1976, SPH.
28. "Medical Evaluation of Federal Program Completed," The Body Politic 4 (October
1976): 4.
29. "Project Established to Improve Maternal Nutrition," The Body Politic 9 (February
1982): 1.
30. "Rural Environmental Education Project End," The Body Politic 7 (January,
1980), 10.
31. "Program Begun to Strengthen Health Education in Cameroon," The Body
Politic 6 (September 1978): 8.
32. A 1975 survey of the deans of the schools of public health ranked the Uni-
versity of North Carolina second overall. Epidemiology, environmental sciences
and engineering, biostatistics, and parasitology and laboratory practice, how-
ever, ranked as the best in the nation. "SPH Ranked Second," The Body Politic
3 (March 1975): 2; "New Contract Awarded Lipids Center," The Body Politic 7
(October 1979): 6.
33. Val Lauder, "Re: The Russians," The Body Politic 4 (Summer 1976): 4.
34. Russell E Christman, "ESE Looks Ahead," The Body Politic 3 Oune 1975): 1.
35. "School Participates in Rubber Industry Research," TKe Body Politic 1 Qune
1973): 6. Dr. Robert Lee Harris, Jr., the former director of the Bureau of
Abatement and Control, of the National Air Pollution Control Administra-
tion, took over as director of the Occupational Health Studies Group in
1975. The group continued its arrangements with the rubber industry until
the early 1980s, when it began investigating similar problems in other indus-
tries. See School of Public Health Annual Report, 1975-76 (Chapel Hill: School
of Public Health, 1976), 21.
191
36. "Hypertension in Rural Communities Studied," The Body Politic 7 (October
1979): 7.
37. Annua; Repon, 1975-76 (Chapel Hill: School of Public Health, 1976), 27.
38. Small interview; Self-Study Report, 1981 (Chapel Hill: School of Public Health,
1981), 131; "American Indian Recruitment Officer Named," The Body Politic 7
Ganuary 1980): 2.
39. Small interview.
in. ^ iii M^JJi^^
■nr
UE
1. Institute of Medicine, The Future of Public Health (Washington, D. C: National
Academy Press, 1988), 19.
2. Annual Report, 1978-79 (Chapel Hill: School of Public Health, 1979), 21, 29, 47;
Annual Report, 1988-89 (Chapel Hill: School of Public Health, 1989), 2-17.
3. The Body Politic 8 (November 1980): 1.
4. Ibrahim interview.
5. Ibid.
6. Ibid.
7. The Body Politic 12 Qune 1985): 4.
8. Memorandum by Strategic Planning Committee, January 18, 1989, SPH.
192
STATE LIBRARY OF NORTH CAROLINA
3 3091 00747 4927
^
p
REVENTIVE medicine dreams of a time
when there shall be enough for all, and
every man shall bear his share of labor in
accordance with his ability, and every man shall
possess sufficient for the needs of his body and the
demands of health. These things he shall have
as a matter of justice and not of charity.
Preventive medicine dreams of a time when
there shall be no unnecessary suffering and no pre-
mature deaths; when the welfare of the people shall
be our highest concern; when humanity and mercy
shall replace greed and selfishness; and it dreams that
all these things will be accomplished through the
wisdom of man. Preventive medicine dreams
of these things, not with the hope that we, individ-
ually, may participate in them, but with the joy that
we may aid in their coming to those who shall live
after us. When young men have vision the
dreams of old men come true."
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